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ACKNOWLEDGMENTS Preparation of this report was supported by the National Center for Telehealth & Technology (T2) Suicide Risk Management & Surveillance Office (SRMSO) research team, including Debi Harris. SRMSO acknowledges the contributions of several individuals to the development and refinement of the DoD Suicide Event Report (DoDSER). Commander Aaron Werbel, Ph.D. (Marine Corps Suicide Prevention Program Manager [SPPM]), Lieutenant Colonel Michael Kindt, Ph.D. (Air Force SPPM), Lieutenant Commander Bonnie Chavez, Ph.D. (Navy SPPM) and Mr. Walter Morales (Army SPPM) were instrumental in the development of the Service s DoDSER program. In addition, we thank Major Lisa Hull, DVM, MPH, DACVPM, the Army DoDSER Project Officer in the Behavioral & Social Health Outcomes Program for her leadership in the Army s DoDSER program. T2 is especially grateful to Lynne Oetjen- Gerdes and Captain Joyce Cantrell, M.D., MPH, of the Mortality Surveillance Division of the Armed Forces Medical Examiner System. Their notification of confirmed suicides, provision of the demographic data presented in this report, and general support for the DoDSER project have been key to the project s success. DoDSER data would not be available without the hard work of the providers and Command appointees across the Services. Authors: David D. Luxton, Ph.D., Nancy A. Skopp, Ph.D., Julie T. Kinn, Ph.D., Nigel E. Bush, Ph.D., Mark A. Reger, Ph.D., Gregory A. Gahm, Ph.D. Page i
CONTENTS ACKNOWLEDGMENTS... i LIST OF TABLES... iv LIST OF FIGURES... viii EXECUTIVE SUMMARY... 1 Background... 1 Results... 1 Conclusion... 3 Chapter 1 INTRODUCTION... 4 Background... 4 Method... 5 Chapter 2 DoD-WIDE RESULTS FOR COMPLETED SUICIDES... 10 DoDSER Submissions... 10 Dispositional/Personal Factors... 11 Contextual Factors... 22 Historical/Developmental Factors... 31 Deployment Factors... 37 Summary... 39 Chapter 3 DoD-WIDE RESULTS FOR COMPLETED SUICIDES IN OEF/OIF AND NON-OEF/OIF LOCATIONS... 40 Dispositional/Personal Factors... 40 Contextual Factors... 51 Clinical/Symptom Factors... 52 Historical/Developmental Factors... 60 Deployment Factors... 68 Summary... 71 Chapter 4 AIR FORCE RESULTS FOR COMPLETED SUICIDES... 72 Air Force DoDSER Submissions and POC Compliance... 72 Dispositional/Personal Factors... 72 Contextual Factors... 79 Clinical/Symptom Factors... 81 Historical/Developmental Factors... 87 Deployment Factors... 91 Summary... 93 Chapter 5 ARMY RESULTS... 94 Army Results for Completed Suicides... 94 Army DoDSER Submissions for Completed Suicides, and POC Compliance... 94 Page ii
Contents Dispositional/Personal Factors... 94 Contextual Factors... 102 Clinical/Symptom Factors... 105 Historical/Developmental Factors... 110 Deployment Factors... 115 Army Results for Non-Fatal Events... 117 Army DoDSERs Submitted for Non-Fatal Events... 118 Dispositional/Personal Factors... 118 Contextual Factors... 131 Clinical/Symptom Factors... 134 Historical/Developmental Factors... 143 Deployment Factors... 151 Summary... 153 Chapter 6 MARINE CORPS RESULTS FOR COMPLETED SUICIDES... 154 DoDSER Submissions and POC Compliance... 154 Dispositional/Personal Factors... 154 Contextual Factors... 160 Clinical/Symptom Factors... 162 Historical/Developmental Factors... 168 Deployment Factors... 172 Summary... 174 Chapter 7 NAVY RESULTS FOR COMPLETED SUICIDES... 175 Navy DoDSER Submissions and POC Compliance... 175 Dispositional/Personal Factors... 175 Contextual Factors... 181 Clinical/Symptom Factors... 184 Historical/Developmental Factors... 189 Deployment Factors... 193 Summary... 195 REFERENCES... 196 ABBREVIATION, ACRONYM, AND INITIALISM LIST... 197 FEEDBACK AND SUGGESTIONS... 198 Page iii
LIST OF TABLES Chapter 2 DOD-WIDE RESULTS FOR COMPLETED SUICIDES TABLE 2.1 2009 AFMES CONFIRMED AND PENDING SUICIDES AND DODSERS SUBMITTED... 10 TABLE 2.2 2009 AND 2008 AFMES DEMOGRAPHICS AND SUICIDE RATES... 12 TABLE 2.3 2009 DMDC DEMOGRAPHICS BY SERVICE... 14 TABLE 2.4 2009 AND 2008 DODSER EVENT COUNTRY... 16 TABLE 2.5 2009 AND 2008 DODSER EVENT SETTING... 16 TABLE 2.6 2009 AND 2008 DODSER EVENT METHOD... 17 TABLE 2.7 2009 AND 2008 DODSER SUBSTANCE(S) USED DURING EVENT... 18 TABLE 2.8 2009 AND 2008 DODSER OTHER EVENT INFORMATION... 20 TABLE 2.9 2009 AND 2008 DODSER NUMBER OF TYPES OF RECIPIENTS OF COMMUNICATED INTENT... 21 TABLE 2.10 2009 AND 2008 DODSER RECIPIENTS OF COMMUNICATED INTENT... 21 TABLE 2.11 2009 AND 2008 DODSER MODE OF COMMUNICATED INTENT... 22 TABLE 2.12 2009 AND 2008 DODSER HOME ENVIRONMENT... 22 TABLE 2.13 2009 AND 2008 DODSER DUTY ENVIRONMENT... 23 TABLE 2.14 2009 AND 2008 DODSER SUICIDE EVENTS BY MONTH... 24 TABLE 2.15 2009 AND 2008 DODSER PRIOR SELF-INJURY... 25 TABLE 2.16 2009 AND 2008 DODSER COMORBIDITY RATES... 26 TABLE 2.17 2009 AND 2008 DODSER MOOD DISORDERS... 27 TABLE 2.18 2009 AND 2008 DODSER ANXIETY DISORDERS... 27 TABLE 2.19 2009 AND 2008 DODSER OTHER BEHAVIORAL HEALTH DISORDERS... 28 TABLE 2.20 2009 AND 2008 DODSER TREATMENT HISTORY... 30 TABLE 2.21 2009 AND 2008 DODSER PSYCHOTROPIC MEDICATION USE... 31 TABLE 2.22 2009 AND 2008 DODSER RELATIONSHIP HISTORY... 33 TABLE 2.23 2009 AND 2008 DODSER FAMILY HISTORY... 33 TABLE 2.24 2009 AND 2008 DODSER ADMIN/LEGAL HISTORY... 35 TABLE 2.25 2009 AND 2008 DODSER ABUSE HISTORY... 36 TABLE 2.26 2009 AND 2008 DODSER FINANCIAL AND WORKPLACE DIFFICULTIES... 37 TABLE 2.27 2009 AND 2008 DODSER EVER DEPLOYED TO OEF/OIF... 38 TABLE 2.28 2009 AND 2008 DODSER COMBAT HISTORY... 38 Chapter 3 DOD-WIDE RESULTS FOR COMPLETED SUICIDES IN OEF/OIF AND NON-OEF/OIF LOCATIONS TABLE 3.1 2009 AND 2008 SUICIDES IN OEF/OIF AND NON-OEF/OIF EVENTS... 40 TABLE 3.2 2009 AND 2008 DODSER DEMOGRAPHICS FOR OEF/OIF AND NON-OEF/OIF EVENTS... 42 TABLE 3.3 2009 AND 2008 DODSER EVENT SETTING FOR OEF/OIF AND NON-OEF/OIF EVENTS... 44 TABLE 3.4 2009 AND 2008 DODSER EVENT METHOD FOR OEF/OIF AND NON-OEF/OIF EVENTS... 46 TABLE 3.5 2009 AND 2008 DODSER SUBSTANCE(S) USED DURING EVENT FOR OEF/OIF AND NON-OEF/OIF EVENTS... 47 TABLE 3.6 2009 AND 2008 DODSER RECIPIENTS OF COMMUNICATED INTENT FOR OEF/OIF AND NON-OEF/OIF EVENTS... 48 TABLE 3.7 2009 AND 2008 DODSER NUMBER OF TYPES OF RECIPIENTS OF COMMUNICATED INTENT FOR OEF/OIF AND NON-OEF/OIF EVENTS... 49 TABLE 3.8 2009 AND 2008 DODSER MODE OF COMMUNICATED INTENT FOR OEF/OIF AND NON-OEF/OIF EVENTS... 49 TABLE 3.9 2009 AND 2008 DODSER OTHER EVENT INFORMATION FOR OEF/OIF AND NON-OEF/OIF EVENTS... 50 TABLE 3.10 2009 AND 2008 DODSER HOME ENVIRONMENT FOR OEF/OIF AND NON-OEF/OIF EVENTS... 51 TABLE 3.11 2009 AND 2008 DODSER SUICIDE EVENTS BY MONTH FOR OEF/OIF AND NON-OEF/OIF EVENTS... 52 TABLE 3.12 2009 AND 2008 DODSER PRIOR SELF-INJURY FOR OEF/OIF AND NON-OEF/OIF EVENTS... 53 TABLE 3.13 2009 AND 2008 DODSER COMORBIDITY RATES FOR OEF/OIF AND NON-OEF/OIF EVENTS... 54 TABLE 3.14 2009 AND 2008 DODSER MOOD DISORDERS FOR OEF/OIF AND NON-OEF/OIF EVENTS... 54 TABLE 3.15 2009 AND 2008 DODSER ANXIETY DISORDERS FOR OEF/OIF AND NON-OEF/OIF EVENTS... 56 TABLE 3.16 2009 AND 2008 DODSER OTHER BEHAVIORAL HEALTH DISORDERS FOR OEF/OIF AND NON-OEF/OIF EVENTS... 57 Page iv
List of Tables TABLE 3.17 2009 AND 2008 DODSER TREATMENT HISTORY FOR OEF/OIF AND NON-OEF/OIF EVENTS... 58 TABLE 3.18 2009 AND 2008 DODSER PSYCHOTROPIC MEDICATION USE FOR OEF/OIF AND NON-OEF/OIF EVENTS... 60 Chapter 3 DoD-WIDE RESULTS FOR COMPLETED SUICIDES IN OEF/OIF AND-NON OEF/OIF LOCATIONS (cont.) TABLE 3.19 2009 AND 2008 DODSER RELATIONSHIP HISTORY FOR OEF/OIF AND NON-OEF/OIF EVENTS... 61 TABLE 3.20 2009 AND 2008 DODSER FAMILY HISTORY FOR OEF/OIF AND NON-OEF/OIF EVENTS... 62 TABLE 3.21 2009 AND 2008 DODSER ADMIN/LEGAL HISTORY FOR OEF/OIF AND NON-OEF/OIF EVENTS... 63 TABLE 3.22 2009 AND 2008 DODSER ABUSE HISTORY FOR OEF/OIF AND NON-OEF/OIF EVENTS... 65 TABLE 3.23 2009 AND 2008 DODSER FINANCIAL AND WORKPLACE DIFFICULTIES FOR OEF/OIF AND NON-OEF/OIF EVENTS... 67 TABLE 3.24 2009 AND 2008 DODSER NUMBER OF DEPLOYMENTS FOR OEF/OIF AND NON-OEF/OIF EVENTS... 69 TABLE 3.25 2009 AND 2008 DODSER COMBAT HISTORY FOR OEF/OIF AND NON-OEF/OIF EVENTS... 70 Chapter 4 AIR FORCE RESULTS FOR COMPLETED SUICIDES TABLE 4.1 2009 AIR FORCE AFMES CONFIRMED AND PENDING SUICIDES AND DODSERS SUBMITTED... 72 TABLE 4.2 2009 AND 2008 AFMES AIR FORCE DEMOGRAPHICS... 72 TABLE 4.3 2009 AND 2008 AIR FORCE DODSER EVENT SETTING... 74 TABLE 4.4 2009 AND 2008 AIR FORCE DODSER EVENT COUNTRY... 74 TABLE 4.5 2009 AND 2008 AIR FORCE DODSER EVENT METHOD... 75 TABLE 4.6 2009 AIR FORCE DODSER EVENT MOTIVATION... 76 TABLE 4.7 2009 AND 2008 AIR FORCE DODSER SUBSTANCE(S) USED DURING EVENT... 76 TABLE 4.8 2009 AND 2008 AIR FORCE DODSER NUMBER OF TYPES OF RECIPIENTS OF COMMUNICATED INTENT... 77 TABLE 4.9 2009 AND 2008 AIR FORCE DODSER MODE OF COMMUNICATED INTENT... 77 TABLE 4.10 2009 AND 2008 AIR FORCE DODSER RECIPIENTS OF COMMUNICATED INTENT... 78 TABLE 4.11 2009 AND 2008 AIR FORCE DODSER OTHER EVENT INFORMATION... 78 TABLE 4.12 2009 AND 2008 AIR FORCE DODSER HOME ENVIRONMENT... 79 TABLE 4.13 2009 AND 2008 AIR FORCE DODSER DUTY ENVIRONMENT... 80 TABLE 4.14 2009 AND 2008 AIR FORCE DODSER SUICIDE EVENTS BY MONTH... 81 TABLE 4.15 2009 AND 2008 AIR FORCE DODSER PRIOR SELF-INJURY... 82 TABLE 4.16 2009 AND 2008 AIR FORCE DODSER COMORBIDITY RATES... 83 TABLE 4.17 2009 AND 2008 AIR FORCE DODSER MOOD DISORDERS... 83 TABLE 4.18 2009 AND 2008 AIR FORCE DODSER ANXIETY DISORDERS... 84 TABLE 4.19 2009 AND 2008 AIR FORCE DODSER OTHER BEHAVIORAL HEALTH DISORDERS... 84 TABLE 4.20 2009 AND 2008 AIR FORCE DODSER TREATMENT HISTORY... 85 TABLE 4.21 2009 AND 2008 AIR FORCE DODSER PSYCHOTROPIC MEDICATION USE... 86 TABLE 4.22 2009 AND 2008 AIR FORCE DODSER RELATIONSHIP HISTORY... 88 TABLE 4.23 2009 AND 2008 AIR FORCE DODSER FAMILY HISTORY... 88 TABLE 4.24 2009 AND 2008 AIR FORCE DODSER ADMIN/LEGAL HISTORY... 89 TABLE 4.25 2009 AND 2008 AIR FORCE DODSER ABUSE HISTORY... 90 TABLE 4.26 2009 AND 2008 AIR FORCE DODSER FINANCIAL AND WORKPLACE DIFFICULTIES... 91 TABLE 4.27 2009 AND 2008 AIR FORCE DODSER EVER DEPLOYED TO OEF/OIF... 92 TABLE 4.28 2009 AND 2008 AIR FORCE DODSER COMBAT HISTORY... 92 Chapter 5 ARMY RESULTS TABLE 5.1 2009 ARMY AFMES CONFIRMED AND PENDING SUICIDES AND DODSERS SUBMITTED... 94 TABLE 5.2 2009 AND 2008 AFMES ARMY DEMOGRAPHICS... 95 TABLE 5.3 2009 AND 2008 ARMY DODSER EVENT COUNTRY FOR COMPLETED SUICIDES... 96 TABLE 5.4 2009 AND 2008 ARMY DODSER EVENT SETTING FOR COMPLETED SUICIDES... 97 TABLE 5.5 2009 AND 2008 ARMY DODSER EVENT METHOD FOR COMPLETED SUICIDES... 98 TABLE 5.6 2009 AND 2008 ARMY DODSER EVENT MOTIVATION FOR COMPLETED SUICIDES... 99 TABLE 5.7 2009 AND 2008 ARMY DODSER SUBSTANCE(S) USED DURING EVENT FOR COMPLETED SUICIDES... 99 TABLE 5.8 2009 AND 2008 ARMY DODSER NUMBER OF TYPES OF RECIPIENTS OF COMMUNICATED INTENT FOR COMPLETED SUICIDES... 100 TABLE 5.9 2009 AND 2008 ARMY DODSER RECIPIENTS OF COMMUNICATED INTENT FOR COMPLETED SUICIDES... 101 TABLE 5.10 2009 AND 2008 ARMY DODSER MODE OF COMMUNICATED INTENT FOR COMPLETED SUICIDES... 101 TABLE 5.11 2009 AND 2008 ARMY DODSER OTHER EVENT INFORMATION FOR COMPLETED SUICIDES... 102 TABLE 5.12 2009 AND 2008 ARMY DODSER HOME ENVIRONMENT FOR COMPLETED SUICIDES... 103 Page v
List of Tables TABLE 5.13 2009 AND 2008 ARMY DODSER DUTY ENVIRONMENT FOR COMPLETED SUICIDES... 104 TABLE 5.14 2009 AND 2008 ARMY DODSER SUICIDE EVENTS BY MONTH FOR COMPLETED SUICIDES... 104 Chapter 5 ARMY RESULTS (cont.) TABLE 5.15 2009 AND 2008 ARMY DODSER PRIOR SELF-INJURY FOR COMPLETED SUICIDES... 105 TABLE 5.16 2009 AND 2008 ARMY DODSER MOOD DISORDERS FOR COMPLETED SUICIDES... 106 TABLE 5.17 2009 AND 2008 ARMY DODSER ANXIETY DISORDERS FOR COMPLETED SUICIDES... 106 TABLE 5.18 2009 AND 2008 ARMY DODSER OTHER BEHAVIORAL HEALTH DISORDERS FOR COMPLETED SUICIDES... 107 TABLE 5.19 2009 AND 2008 ARMY DODSER COMORBIDITY RATES FOR COMPLETED SUICIDES... 108 TABLE 5.20 2009 AND 2008 ARMY DODSER TREATMENT HISTORY FOR COMPLETED SUICIDES... 108 TABLE 5.21 2009 AND 2008 ARMY DODSER PSYCHOTROPIC MEDICATION USE FOR COMPLETED SUICIDES... 110 TABLE 5.22 2009 AND 2008 ARMY DODSER RELATIONSHIP HISTORY FOR COMPLETED SUICIDES... 111 TABLE 5.23 2009 AND 2008 ARMY DODSER FAMILY HISTORY FOR COMPLETED SUICIDES... 111 TABLE 5.24 2009 AND 2008 ARMY DODSER ADMIN/LEGAL HISTORY FOR COMPLETED SUICIDES... 112 TABLE 5.25 2009 AND 2008 ARMY DODSER ABUSE HISTORY FOR COMPLETED SUICIDES... 113 TABLE 5.26 2009 AND 2008 ARMY DODSER FINANCIAL AND WORKPLACE DIFFICULTIES FOR COMPLETED SUICIDES... 114 TABLE 5.27 2009 AND 2008 ARMY DODSER EVER DEPLOYED TO OEF/OIF FOR COMPLETED SUICIDES... 115 TABLE 5.28 2009 AND 2008 ARMY DODSER COMBAT HISTORY FOR COMPLETED SUICIDES... 116 TABLE 5.29 2009 AND 2008 NON-FATAL ARMY DODSERS SUBMITTED... 118 TABLE 5.30 2009 AND 2008 NON-FATAL ARMY DODSER DEMOGRAPHICS... 119 TABLE 5.31 2009 AND 2008 NON-FATAL ARMY DODSER EVENT COUNTRY... 121 TABLE 5.32 2009 AND 2008 NON-FATAL ARMY DODSER EVENT SETTING... 122 TABLE 5.33 2009 AND 2008 NON-FATAL ARMY DODSER EVENT METHOD... 124 TABLE 5.34 2009 AND 2008 NON-FATAL ARMY DODSER EVENT MOTIVATION... 125 TABLE 5.35 2009 AND 2008 NON-FATAL ARMY DODSER POST-EVENT ACTIONS... 126 TABLE 5.36 2009 AND 2008 NON-FATAL ARMY DODSER SUBSTANCE(S) USED DURING EVENT... 126 TABLE 5.37 2009 AND 2008 NON-FATAL ARMY DODSER RECIPIENTS OF COMMUNICATED INTENT... 128 TABLE 5.38 2009 AND 2008 NON-FATAL ARMY DODSER NUMBER OF TYPES OF RECIPIENTS OF COMMUNICATED INTENT... 129 TABLE 5.39 2009 AND 2008 NON-FATAL ARMY DODSER MODE OF COMMUNICATED INTENT... 129 TABLE 5.40 2009 AND 2008 NON-FATAL ARMY DODSER OTHER EVENT INFORMATION... 130 TABLE 5.41 2009 AND 2008 NON-FATAL ARMY DODSER HOME ENVIRONMENT... 131 TABLE 5.42 2009 AND 2008 NON-FATAL ARMY DODSER DUTY ENVIRONMENT... 133 TABLE 5.43 2009 AND 2008 NON-FATAL ARMY DODSER SUICIDE EVENTS BY MONTH... 134 TABLE 5.44 2009 AND 2008 NON-FATAL ARMY DODSER PRIOR SELF-INJURY... 135 TABLE 5.45 2009 AND 2008 NON-FATAL ARMY DODSER COMORBIDITY RATES... 136 TABLE 5.46 2009 AND 2008 NON-FATAL ARMY DODSER MOOD DISORDERS... 137 TABLE 5.47 2009 AND 2008 NON-FATAL ARMY DODSER ANXIETY DISORDERS... 138 TABLE 5.48 2009 AND 2008 NON-FATAL ARMY DODSER OTHER BEHAVIORAL HEALTH DISORDERS... 139 TABLE 5.49 2009 AND 2008 NON-FATAL ARMY DODSER TREATMENT HISTORY... 140 TABLE 5.50 2009 AND 2008 NON-FATAL ARMY DODSER PSYCHOTROPIC MEDICATION USE... 142 TABLE 5.51 2009 AND 2008 NON-FATAL ARMY DODSER RELATIONSHIP HISTORY... 143 TABLE 5.52 2009 AND 2008 NON-FATAL ARMY DODSER FAMILY HISTORY... 144 TABLE 5.53 2009 AND 2008 NON-FATAL ARMY DODSER ADMIN/LEGAL HISTORY... 146 TABLE 5.54 2009 AND 2008 NON-FATAL ARMY DODSER ABUSE HISTORY... 148 TABLE 5.55 2009 AND 2008 NON-FATAL ARMY DODSER FINANCIAL AND WORKPLACE DIFFICULTIES... 150 TABLE 5.56 2009 AND 2008 NON-FATAL ARMY DODSER EVER DEPLOYED TO OEF/OIF... 151 TABLE 5.57 2009 AND 2008 NON-FATAL ARMY DODSER COMBAT HISTORY... 152 Chapter 6 MARINE CORPS RESULTS FOR COMPLETED SUICIDES TABLE 6.1 2009 MARINE CORPS AFMES CONFIRMED AND PENDING SUICIDES AND DODSERS SUBMITTED... 154 TABLE 6.2 2009 AND 2008 AFMES MARINE CORPS DEMOGRAPHICS... 154 TABLE 6.3 2009 AND 2008 MARINE CORPS DODSER EVENT COUNTRY... 156 TABLE 6.4 2009 AND 2008 MARINE CORPS DODSER EVENT SETTING... 156 TABLE 6.5 2009 AND 2008 MARINE CORPS DODSER EVENT METHOD... 157 TABLE 6.6 2009 AND 2008 MARINE CORPS DODSER SUBSTANCE(S) USED DURING EVENT... 158 TABLE 6.7 2009 AND 2008 MARINE CORPS DODSER NUMBER OF TYPES OF RECIPIENTS OF COMMUNICATED INTENT... 158 Page vi
List of Tables TABLE 6.8 2009 AND 2008 MARINE CORPS DODSER MODE OF COMMUNICATED INTENT... 159 TABLE 6.9 2009 AND 2008 MARINE CORPS DODSER RECIPIENTS OF COMMUNICATED INTENT... 159 Chapter 6 MARINE CORPS RESULTS FOR COMPLETED SUICIDES (cont.) TABLE 6.10 2009 AND 2008 MARINE CORPS DODSER OTHER EVENT INFORMATION... 159 TABLE 6.11 2009 AND 2008 MARINE CORPS DODSER HOME ENVIRONMENT... 160 TABLE 6.12 2009 AND 2008 MARINE CORPS DODSER DUTY ENVIRONMENT... 161 TABLE 6.13 2009 AND 2008 MARINE CORPS DODSER SUICIDE EVENTS BY MONTH... 162 TABLE 6.14 2009 AND 2008 MARINE CORPS DODSER PRIOR SELF-INJURY... 163 TABLE 6.15 2009 AND 2008 MARINE CORPS DODSER MOOD DISORDERS... 163 TABLE 6.16 2009 AND 2008 MARINE CORPS DODSER ANXIETY DISORDERS... 164 TABLE 6.17 2009 AND 2008 MARINE CORPS DODSER OTHER BEHAVIORAL HEALTH DISORDERS... 165 TABLE 6.18 2009 AND 2008 MARINE CORPS DODSER COMORBIDITY RATES... 166 TABLE 6.19 2009 AND 2008 MARINE CORPS DODSER TREATMENT HISTORY... 166 TABLE 6.20 2009 AND 2008 MARINE CORPS DODSER PSYCHOTROPIC MEDICATION USE... 167 TABLE 6.21 2009 AND 2008 MARINE CORPS DODSER RELATIONSHIP HISTORY... 168 TABLE 6.22 2009 AND 2008 MARINE CORPS DODSER FAMILY HISTORY... 169 TABLE 6.23 2009 AND 2008 MARINE CORPS DODSER ADMIN/LEGAL HISTORY... 170 TABLE 6.24 2009 AND 2008 MARINE CORPS DODSER ABUSE HISTORY... 171 TABLE 6.25 2009 AND 2008 MARINE CORPS DODSER FINANCIAL AND WORKPLACE DIFFICULTIES... 172 TABLE 6.26 2009 AND 2008 MARINE CORPS DODSER EVER DEPLOYED TO OEF/OIF... 173 TABLE 6.27 2009 AND 2008 MARINE CORPS DODSER COMBAT HISTORY... 173 Chapter 7 NAVY RESULTS FOR COMPLETED SUICIDES TABLE 7.1 2009 NAVY AFMES CONFIRMED AND PENDING SUICIDES AND DODSERS SUBMITTED... 175 TABLE 7.2 2009 AND 2008 AFMES NAVY DEMOGRAPHICS... 176 TABLE 7.3 2009 AND 2008 NAVY DODSER EVENT SETTING... 177 TABLE 7.4 2009 AND 2008 NAVY DODSER EVENT COUNTRY... 177 TABLE 7.5 2009 AND 2008 NAVY DODSER EVENT METHOD... 178 TABLE 7.6 2009 AND 2008 NAVY DODSER SUBSTANCE(S) USED DURING EVENT... 179 TABLE 7.7 2009 AND 2008 NAVY DODSER NUMBER OF TYPES OF RECIPIENTS OF COMMUNICATED INTENT... 180 TABLE 7.8 2009 AND 2008 NAVY DODSER MODE OF COMMUNICATED INTENT... 180 TABLE 7.9 2009 AND 2008 NAVY DODSER RECIPIENTS OF COMMUNICATED INTENT... 180 TABLE 7.10 2009 AND 2008 NAVY DODSER OTHER EVENT INFORMATION... 181 TABLE 7.11 2009 AND 2008 NAVY DODSER HOME ENVIRONMENT... 182 TABLE 7.12 2009 AND 2008 NAVY DODSER DUTY ENVIRONMENT... 183 TABLE 7.13 2009 AND 2008 NAVY DODSER SUICIDE EVENTS BY MONTH... 183 TABLE 7.14 2009 AND 2008 NAVY DODSER PRIOR SELF-INJURY... 184 TABLE 7.15 2009 AND 2008 NAVY DODSER MOOD DISORDERS... 185 TABLE 7.16 2009 AND 2008 NAVY DODSER ANXIETY DISORDERS... 185 TABLE 7.17 2009 AND 2008 NAVY DODSER OTHER BEHAVIORAL HEALTH DISORDERS... 186 TABLE 7.18 2009 AND 2008 NAVY DODSER COMORBIDITY RATES... 187 TABLE 7.19 2009 AND 2008 NAVY DODSER TREATMENT HISTORY... 187 TABLE 7.20 2009 AND 2008 NAVY DODSER PSYCHOTROPIC MEDICATION USE... 188 TABLE 7.21 2009 AND 2008 NAVY DODSER RELATIONSHIP HISTORY... 189 TABLE 7.22 2009 AND 2008 NAVY DODSER FAMILY HISTORY... 190 TABLE 7.23 2009 AND 2008 NAVY DODSER ADMIN/LEGAL HISTORY... 191 TABLE 7.24 2009 AND 2008 NAVY DODSER ABUSE HISTORY... 192 TABLE 7.25 2009 AND 2008 NAVY DODSER FINANCIAL AND WORKPLACE DIFFICULTIES... 193 TABLE 7.26 2009 AND 2008 NAVY DODSER EVER DEPLOYED TO OEF/OIF... 194 TABLE 7.27 2009 AND 2008 NAVY DODSER COMBAT HISTORY... 194 Page vii
LIST OF FIGURES FIGURE 2.1 2009 DODSER SUICIDE METHODS... 17 FIGURE 2.2 2009 COMMUNICATION OF POTENTIAL FOR SELF-HARM... 20 FIGURE 2.3 2009 DODSER SUICIDE COMPLETIONS BY MONTH... 24 FIGURE 2.4 2009 DODSER BEHAVIORAL HEALTH DISORDERS... 26 FIGURE 2.5 2009 DODSER TREATMENT HISTORY... 29 FIGURE 2.6 2009 HISTORY OF FAILED RELATIONSHIPS... 32 FIGURE 2.7 2009 ADMINISTRATIVE/LEGAL HISTORY... 34 FIGURE 3.1 2009 METHODS FOR OEF/OIF AND OTHER SUICIDES... 45 FIGURE 3.2 2009 OEF/OIF MONTHS DEPLOYED... 68 FIGURE 4.1 2009 AND 2008 AIR FORCE DODSER EVENT METHODS... 75 FIGURE 5.1 2009 AND 2008 ARMY DODSER EVENT METHODS... 97 FIGURE 5.2 2009 AND 2008 NON-FATAL ARMY DODSER EVENT METHODS... 123 FIGURE 6.1 2009 AND 2008 MARINE CORPS DODSER EVENT METHODS... 157 FIGURE 7.1 2009 AND 2008 NAVY DODSER EVENT METHODS... 178 Page viii
EXECUTIVE SUMMARY This annual report summarizes data collected on Department of Defense (DoD) suicide events for calendar year 2009 as reported and submitted by 1 April 2010. The report presents overall DoD suicide data as well as Service-specific (Air Force, Army, Marine Corps, and Navy) data. This second year of the program provided the opportunity to present 2009 data relative to 2008. Personally identifiable information has been redacted from this report. Background The DoD Suicide Event Report (DoDSER) was developed to standardize suicide surveillance efforts across the Services with the ultimate goal of facilitating DoD s suicide prevention mission. When a death is ruled a suicide by the Armed Forces Medical Examiner s System (AFMES), each Service has a professional review records, conduct interviews where appropriate, and respond to DoDSER items on a webform that collects comprehensive information about the Service Member and the suicide event. Results The AFMES indicates that 309 Service Members died by suicide in 2009 (Air Force = 46; Army = 164; Marine Corps = 52; Navy = 47). This number includes deaths strongly suspected to be suicides but pending final determination. DoDSERs were received for 97% of AFMES confirmed 2009 suicides as of 1 April 2010. This represented a significant improvement compared to 2008 (90%). Dispositional/Personal Factors Demographic risk factor trends for DoD suicides in 2009 were similar to those reported in 2008 and are generally consistent with those of the US population. [1] In general: Caucasians under the age of 25 who were junior enlisted (E1-E4) or had earned a GED were at increased risk for suicide relative to their respective demographic comparison groups in crude rate comparisons. Although the suicide rate among married persons was similar to the rate for persons who had never married, divorced persons were almost three times more likely to die by suicide than married persons in crude rate comparisons. Page 1
Executive Summary The majority of suicides were completed by Regular Component Service Members (92%, n=284). The suicide rate for these Service Members was 120% higher than the rate for Service Members in the Reserve and National Guard in crude rate comparisons. The majority of decedents used a firearm (59%; 41% of all decedents used a non-military firearm). The second most frequent method of suicide was hanging (23%). Most decedents (72%) had no known history of communicating their potential for self-harm before taking their lives. When potential for self-harm was communicated, this was most frequently disclosed to spouses (13%), followed by friends (9%). Contextual Factors Forty-six percent of decedents lived in off-post housing at the time of the suicide; 31% lived in a shared military environment (barracks, tent, other shared environment). Thirty-seven percent were known to have children, and 17% lived with their children. Firearms were present in the home or immediate environment for 49% of decedents. Clinical/Symptom Factors Seventeen percent of Service Members who died by suicide had a known history of prior selfinjurious behavior. The majority of suicide decedents (57%) did not have a known history of a behavioral health disorder. Eighteen percent had been diagnosed with an anxiety disorder, including 6% diagnosed with PTSD; 25% had a history of a mood disorder. Twenty-four percent had a history of receiving psychotropic medications. Forty-nine percent reportedly received medical, behavioral health, substance abuse, family or chaplaincy services within 30 days of death. Historical/Developmental Factors The DoDSER data provides a description of the stressors decedents experienced prior to dying by suicide. Although these factors are not necessarily causal, they help characterize the circumstances of the decedents lives prior to the suicide. Fifty percent of decedents experienced a failed or failing spousal or intimate partner relationship prior to their suicide; 27% of decedents experienced the relationship problem within 30 days of the suicide. In addition, other failed relationships (non-intimate) were reported for 13% of decedents (8% within 30 days). Legal problems were identified for a minority of individuals. The most common legal problems were Article 15 proceedings (15%) and civil problems (12%). Ten percent had a history of being absent without leave (AWOL). Excessive debt or bankruptcy was identified for 11% of decedents. Job problems were noted for 27% of decedents. Page 2
Deployment Factors DoDSER 2009 Annual Report Executive Summary Most suicides did not occur in theater. There were ten suicides (3%) in Operation Enduring Freedom and 33 (11%) in Operation Iraqi Freedom. Fifty-one percent of decedents had a history of deployment to Operation Enduring Freedom or Operation Iraqi Freedom, and 7% had a history of multiple deployments to Iraq, Afghanistan, or Kuwait. Seventeen percent of decedents had reportedly experienced direct combat operations. Conclusion The DoDSER program is a key aspect of the DoD s suicide prevention program. This second year of DoDSER analyses confirmed many of the patterns described in the 2008 data; there were very few differences between 2008 and 2009. Chapters in the report provide additional details including Servicelevel analyses. Conclusions and interpretations regarding noted patterns must be made cautiously because it is not possible to statistically determine if a given DoDSER variable is a true risk factor for suicide without additional data about the rate of that variable in the population. Page 3
Chapter 1 INTRODUCTION Background This report presents results from all the Department of Defense Suicide Event Reports (DoDSERs) collected for calendar year 2009. The DoDSER is part of a suicide surveillance program that standardizes retrospective suicide surveillance efforts across the Services. Historically, the Services collected suicide surveillance data through separate processes. The Army used the Army Suicide Event Report (ASER), the Air Force used the Suicide Event Surveillance System (SESS), and the Navy and Marine Corps used the Department of the Navy Suicide Incident Report (DoNSIR). A major limitation of these disparate systems was that aggregated DoD-level analyses were not possible since the same data points were not collected with standardized items. In addition, each system had its own strengths and limitations; for example, not all of the Services benefited from an automated, webform data collection process. The DoD s Suicide Prevention and Risk Reduction Committee (SPARRC) provides a venue for collaboration among the Services Suicide Prevention Program Managers (SPPMs) and other stakeholders in the DoD s suicide prevention mission. The SPARRC identified a standardized DoD suicide surveillance system as a key goal. A collaborative plan was developed to synchronize surveillance efforts across Services while also seeking to maintain flexibility to address Service-specific needs. A web-based data collection process was identified as a key goal, and in 2007, a project plan was collaboratively developed by T2 with SPPMs from all of the Services (Air Force, Army, Marine Corps, and Navy). An effort was made to develop a DoD system that built on the best characteristics from each of the Service-specific programs. The resulting DoDSER uses an epidemiological data collection form to collect standardized data on suicide behaviors among Service Members. The DoDSER program was launched 1 January 2008. All the Services are collecting DoDSERs on military suicide deaths. [2] By 1 January 2010, all Services also started collecting DoDSERs on suicide attempts. The Army is also collecting DoDSERs on other non-fatal suicide behaviors (see Method below). This report provides statistics for 2009, with detailed tables presented for DoDSER items. Supplemental materials will be available on the National Center for Telehealth & Technology website (http://t2health.org) after the Report is released. Page 4
Chapter 1 Introduction Method DoDSER Items DoDSER items were developed to provide a comprehensive set of information from a variety of sources to facilitate suicide prevention efforts in the DoD. Development of the current DoDSER content evolved from structured reviews of the Services historical surveillance items, workgroup deliberations with representation from all Services (including the SPPMs), and a systematic review of the literature. Feedback from the Services historical efforts to develop the best possible content informed the development process. Feedback on content from nationally recognized civilian and military experts was also integrated. In addition, suggestions from senior leaders and other stakeholders were provided by some workgroup members. The complete DoDSER 2009 webform can be found online (http://t2health.org). Risk variables are organized into categories for a theoretically meaningful presentation. Although alternative approaches were available and considered, a relevant model successfully implemented in the violence risk assessment literature [3] was selected. Categories are organized as follows: Dispositional or personal factors (e.g., demographics), Historical or developmental factors (e.g., family history, prior suicide behaviors, life events), Contextual factors (e.g., access to firearms, place of residence, duty status), and Clinical or symptom factors (e.g., posttraumatic stress disorder, other behavioral health disorders, or symptoms). These factors were combined with a section on deployment history and a comprehensive set of questions related to the event to form the current DoDSER. DoDSER items are updated once a year on 1 January. The National Center for Telehealth & Technology (T2) leads a series of meetings with all the Services SPPMs and DoDSER Program Managers in collaboration with the SPARRC. The work group reviews feedback received during the prior year and any implications from the evolving scientific literature. All Service representatives concur with all item changes, unless the change relates to a Service-specific need. Because 2009 was only the second year of the program, a priority was placed on maintaining items from 2008 to ensure that comparisons could be made across years. Therefore, no item changes were made on 1 January 2009. Refinements to item content were made on 1 January 2010 and will be reflected in the 2010 annual report. Data Collection Process The DoDSER is a webform that is available via the Internet and submitted via a secure website. The DoDSER data presented here are a descriptive compilation of DoDSERs as they have been completed and submitted by DoDSER respondents across the DoD. Personally identifiable information has been redacted from this report. Page 5
Chapter 1 Introduction DoDSER data included in this report are for suicide events that occurred in 2009 as reported and submitted by 1 April 2010. This date was selected with an acknowledgement that there is a tension between the competing values of timely reporting and complete data collection. Extension of this date has been considered in order to obtain additional DoDSERs, as it may take as long as one year to confirm suicide as the cause of death. The Centers for Disease Control (CDC) addressed this with longer timeframes for reporting (approximately two years). [1] However, the DoD represents a much smaller population, and the vast majority of DoD suicides are determined by 1 April of the following year. The April date was established to maintain consistency with guidance provided by the Under Secretary of Defense (Personnel and Readiness) which requires 90 days between the end of the calendar year and calculation of calendar year suicide data. [4] Data regarding suicide events from 2008 are included. Data from 2008 provided in the figures of this report will vary slightly from the data provided in the 2008 DoDSER Annual Report because the 2008 data set has been updated to include 2008 events confirmed between April 2009 and April 2010. DoDSERs are required for all Active component and activated Reserve and Guard suicides in the DoD. Some Services will exceed this minimum requirement in 2010 (e.g., collect DoDSERs on Selected Reservists (SELRES) not on active duty). In addition, consistent with requirements for standardized DoD suicide rate calculation, [4] DoDSERs are submitted for deaths when a Service s SPPM strongly suspects suicide but the case is still awaiting final determination by the AFMES. This is intended to provide leaders and others working to prevent suicide with the most up-to-date information possible. The risk of overestimation is low; variation between final confirmed and suspected suicides is generally one-to-two cases per year, DoD-wide. DoDSERs are also submitted for some suicide-related behaviors, including suicide attempts, deliberate self-harm, and suicidal ideation. In 2009, the Army was the only Service to collect this data for the entire year, although all Services had implemented a similar methodology for suicide attempts by 1 January 2010. Therefore, this 2009 report includes data on suicide-related behaviors for the Army only. The 2010 report will include similar data for all the Services. DoDSERs are submitted by behavioral health providers (psychologists, psychiatrists, psychiatric nurses, or social workers), health care providers, or a command-appointed representative. Technicians may submit DoDSERs under the supervision of one of these professionals. DoDSER responses are derived from a review of all relevant records. In addition, interviews are conducted in some cases. Following a suicide, respondents review medical and behavioral health records, personnel records, investigative agency records, and records related to the manner of death. Information is also often collected from co-workers, the responsible investigative agency officer, and other professionals or family members (for some Services). For non-fatal suicide behaviors (Army only for 2009), DoDSER respondents frequently conduct interviews with Soldiers to collect some of the required information. Page 6
Chapter 1 Introduction The process for identifying suicides and obtaining DoDSERs is similar across all Services. SPPMs coordinate closely with the AFMES at the Armed Forces Institute of Pathology (AFIP) to maintain an official list of suicides. In the Army, a DoDSER point of contact (POC) and Command POC at each medical treatment facility are notified when a Soldier s death is confirmed as a suicide and requested to complete a DoDSER within 60 days. In the Air Force, the Office of Special Investigations is the primary data collection agency. In the Navy and Marine Corps, the SPPMs office contacts the local Command and requests an appropriate POC to meet the requirement. Data Quality Control Procedures Four primary quality control procedures are followed. First, the data submission website minimizes the possibility of data entry errors. The software uses form field validation to request user clarification when data is not logically possible (e.g., impossible dates). Radio buttons and checkboxes are used to further reduce the chances of data entry errors. Second, data submission requires a DoDSER account in which a user s identity is confirmed with a microchip-containing military ID known as a common access card (CAC). The CAC contains basic information about the owner and is associated with a personal identification number required for login. Therefore, false submissions have not generally occurred. However, suicide event and non-fatal suicide behaviors can be inadvertently misclassified by respondents in the DoDSER system. For example, the manner of death can be ambiguous in some cases, and a well-intentioned DoDSER respondent can misclassify an event. Therefore, DoDSER submissions are confirmed against the official list of DoD suicides provided by AFMES. Third, DoDSERs are analyzed for incorrect data entry. In rare cases, individuals can make a variety of data entry mistakes (such as transposing years) and these are corrected when identified. A conservative approach is taken to correcting errors such that only clear mistakes are corrected. Fourth, all DoDSERs are reviewed to ensure that two or more DoDSERs were not submitted for the same event. Potential duplicates are automatically flagged for the Service s DoDSER Program Manager to determine which submission represents the most complete data, and this DoDSER is used in analyses. DoDSER Submission Compliance DoDSER submission compliance rates were calculated for each Service. In the DoD, DoDSERs for suicides are due within 60 days of notification that a death has been confirmed as a suicide by the AFMES [4] (although some individual Service-level policies require submission sooner). Therefore, the number of DoDSER submissions for each Service was compared to the number of suicides confirmed by AFMES as of 31 January 2010 (60 days prior to the 1 April cut-off date for analysis). As such, DoDSERs that were not yet overdue at the time of the analysis were not counted as being out of compliance. Page 7
Chapter 1 Introduction Demographic Risk Factors The DoDSER collects data on a variety of demographic variables. However, because DoDSERs are not available for 100% of individuals, demographic data were obtained from the Defense Manpower Data Center (DMDC) with assistance from the AFMES. This provided the opportunity to analyze demographic variables as suicide risk factors with the use of DMDC population data. The demographic categories presented in this report are those provided by DMDC. Procedures for calculating rates followed standard DoD reporting procedures. [4] DMDC rates were based on September quarter-end strength reports from DMDC and were obtained by the Mortality Surveillance Division of the AFMES. Race data in the DMDC report is obtained from a self-report source. This report reflects the most current data available at the time of writing, but some data is subject to variation over time due to updates from the various sources used to populate the database. In most cases, DMDC data is used in this report for demographic analyses. In a few analyses where DMDC data were not available (e.g., nonfatal suicide-related behaviors in the Army Chapter), DoDSER demographics were used. Suicide rates based on fewer than 20 individuals may be unstable and are therefore suppressed. Suicide rate ratios (RR), based on population rates provided by DMDC data, are calculated to compare groups based on demographic characteristics. Interpretive Considerations The purpose of this report is to provide a broad presentation of DoDSER items to support a wide variety of possible needs. Given the very large number of possible comparisons between 2008 and 2009, and the fact that we did not approach the data with a priori hypotheses, we did not compute statistical analyses to compare years. The probability of finding statistically significant results by chance, even when no real difference exists, would be high. Enough data is presented in most cases to permit readers to conduct such analyses, if of interest. Further, data analyses and descriptive information of small sample sizes should always be interpreted with caution due to random error or potential outlier biases inherent in small samples. DoDSER data is useful to help characterize the nature of suicide events. With a few exceptions (e.g., demographic characteristics), it is not possible to statistically determine if a given DoDSER variable is a risk factor for suicide. In order to determine risk, additional data is required about the rate of the variable in the population. For example, it is not possible to determine if owning a firearm is a risk factor for suicide without examining the rate of owning a firearm in the military population. A pilot study to collect control DoDSER data is underway, and other efforts to improve the interpretive value of the DoDSER data are being pursued. It is also important to note how the don t know option that is provided for many DoDSER items can influence the interpretation of results. The information required to answer some DoDSER items may only be available for some respondents who benefited from detailed medical records or interviews with Page 8
Chapter 1 Introduction knowledgeable persons familiar with the decedent s history. Therefore, don t know responses are expected for some items. Percentages were often calculated based on the total number of responses, including don t know responses. If one group has a higher don t know response rate than comparison groups, it influences the way the data appear. In some cases, percentages do not add up to 100% due to rounding error. The nature of the item of interest should be taken into account when results are interpreted. Some DoDSER items are highly objective, whereas others are more subjective. Some results are therefore very reliable, while others reflect the best data available on a difficult to study topic that is provided by a respondent who is knowledgeable about the case. Reliability and validity of DoDSER items is not known at this time. Standardized coding guidance was available to respondents for many DoDSER items, and a more detailed coding manual is currently being finalized. Future Directions The DoDSER program continues to evolve, largely due to feedback received from leadership in the Services, SPPMs, and others (see FEEDBACK AND SUGGESTIONS). By 1 January 2010, all Services began systematically collecting DoDSERs for non-fatal events. In addition to the Army s current section on nonfatal events, the 2010 report will include thorough data on non-fatalities for the Air Force, Marine Corps, and Navy. T2 s Suicide Risk Management & Surveillance Office is working with SPPMs and SPARRC to finalize a refined DoDSER coding manual to help ensure standardization across DoDSER respondents. T2 also recently deployed Internet and video-based DoDSER training materials to promote consistency in DoDSER responses. In addition to benefitting from these changes, the 2010 report will provide an opportunity to capitalize on three years of data collection. As such, the next report will include longitudinal analyses. Page 9
Chapter 2 DoD-WIDE RESULTS FOR COMPLETED SUICIDES DoDSER Submissions According to data provided by the Armed Forces Medical Examiner System (AFMES), there were 309 Service Member suicides in calendar year 2009 (Air Force = 46; Army = 164; Marine Corps = 52; Navy = 47; Table 2.1). These include eight Reservists and 17 National Guard Members on Active Duty (Army = 17; Air Force = 5; Navy = 2; Marine Corps = 1). The 309 suicides include decedents whose cause of death is currently being determined by AFMES. Table 2.1 2009 AFMES CONFIRMED AND PENDING SUICIDES AND DoDSERs SUBMITTED Total DoDSERs Received Total AFMES Confirmed and Pending Suicides AFMES Confirmed Suicides (as of 31 JAN 2010) DoDSER Submission Compliance Additional DoDSERs Pending AFMES Confirmation AIR FORCE 46 46 43 43 (100%) 3 ARMY 153 164 161 153 (95%) 0 MARINE CORPS 52 52 50 50 (100%) 2 NAVY 46 47 45 45 (100%) 1 Total DoD 297 309 299 291 (97%) 6 Note: Data from 1/1/2009 through 12/31/2009 as of 4/1/2010 As noted in Chapter 1, Method, the DoD standard requires a Department of Defense Suicide Event Report (DoDSER) submission within 60 days of notification that a death has been confirmed as a suicide by AFMES [4] (although some individual Service-level policies require faster submission). Therefore, the number of DoDSER submissions was compared to the number of suicides confirmed by AFMES as of 31 January 2010 (60 days prior to the 1 April cut-off date for analysis). As of 31 January 2010, there were 299 AFMES confirmed suicides (Air Force = 43; Army = 161; Marine Corps = 50; Navy = 45). For 2009, there were 297 DoDSERs submitted for suicides plus six DoDSERs submitted for deaths pending AFMES determination (Air Force = 46; Army = 153; Marine Corps = 52; Navy = 46), for an overall DoDSER submission compliance rate of 97% (100% for Air Force, 95% for Army, 100% for the Marine Corps, and 100% for Navy). 2009 Suicide Rate Data Suicide rate data are maintained by the AFMES and are not calculated with DoDSER data. Suicide data provided by the AFMES is included in this report to provide a context for interpreting DoDSER data. Page 10
Chapter 2 DoD-Wide Results for Completed Suicides The total Active Duty crude suicide rate (including Active Duty Guard and Reserve) was 18.4. Crude rates for 2009 by Service were Air Force = 12.4, Army = 22.0, Marine Corps = 24.0, and Navy = 13.5. Dispositional/Personal Factors This section reports data that describe internal characteristics or individual behaviors of decedents that may have been associated with or contributed to the suicidal events. These factors include decedents demographic characteristics, event setting, suicide method, substance use during the event, possible motive and intent to die, and communication of intent with others. Demographics Table 2.2 summarizes 2009 suicide demographic data based on Defense Manpower Data Center (DMDC) data provided by AFMES, and Table 2.3 shows the data by Service. Although the DoDSER does collect demographic data, use of DMDC data permitted the calculation of suicide rates because the same data is available for the DoD population (described in Chapter 1, Method). In addition, DMDC demographic data were provided for the few cases in which a DoDSER had not yet been received. Thus, demographic data were available for all suicide cases (n=309), whereas the rest of the report utilizes DoDSER data (n=297). Ninety-seven percent (n=300) of suicides were completed by men. Although the number of women s suicides was too low to calculate a stable rate, exploratory analysis suggests that the risk of suicide was higher for men than for women. The majority of suicides were completed by Caucasians (80%, n=247). Caucasians were 76% more likely to die by suicide compared to African Americans (RR=1.76). It was not possible to compare other race groups due to the small cell sizes. Suicide was most frequently observed among persons under age 25 (46%, n=141). This group had a 36% higher risk of suicide compared to all other age groups combined (RR=1.36). Most suicides (54%, n=167) were completed by junior enlisted (E1-E4) personnel followed by middle to senior (E5-E9) enlisted personnel (36%, n=112). Junior enlisted (E1-E4) personnel were 48% more likely to die by suicide compared to more senior enlisted personnel (RR=1.48). Also, enlisted personnel (E1-E9) were more than twice as likely to die by suicide compared to officers (RR=2.02). The highest level of education achieved by the majority of decedents in 2009 was graduation from high school (67%, n=208). The risk for suicide for persons with less than a high school education (GED/below high school) was 2.4 times higher compared to persons with a high school education (RR=2.44). About half of the suicides (51%, n=159) were completed by married persons. Although the suicide rate among married persons did not differ from never married persons (RR=1.06), divorced persons were almost three times as likely to die by suicide as married persons (RR=2.91). The relative risk was only slightly reduced when gender-adjusted (RR=2.71). The majority of suicides were completed by Active Duty personnel (92%, n=284) and the risk for suicide for Regular Active Duty personnel was 2.1 times higher than for Reservists and National Guard combined (RR=2.10). Page 11
Chapter 2 DoD-Wide Results for Completed Suicides Comparisons were not conducted within individual Services because the vast majority of cell sizes were too small to permit calculation of stable suicide rates. Table 2.2 2009 AND 2008 AFMES DEMOGRAPHICS AND SUICIDE RATES GENDER RACE RANK EDUCATION MARITAL STATUS AGE* Count % DoD Total % Rate Count DoD Total % Rate Male 300 97% 85% 21.03 255 95% 18.20 Female 9 3% 15% N/A 13 5% N/A American Indian/Alaskan Native 10 3% 2% N/A 9 3% N/A Asian/Pacific Islander 15 5% 4% N/A 11 4% N/A Black/African American 33 11% 17% 11.80 33 12% 11.9 White/Caucasian 247 80% 71% 20.82 204 76% 17.4 Other/DK 4 1% 7% N/A 11 4% N/A Unknown Enlisted 3 1% N/A N/A 1 <1% N/A E1-E4 167 54% 42% 24.06 138 51% 20.1 E5-E9 112 36% 41% 16.26 102 38% 14.8 Officer 23 7% 15% 9.32 25 9% 10.2 Warrant Officer 4 1% 1% N/A 2 1% N/A Below HS 2 1% 1% N/A 9 3% N/A GED 44 14% 6% 45.21 24 9% 24.1 HS graduate 208 67% 63% 19.91 170 63% 16.4 Some College/tech, no degree 16 5% 5% N/A 4 1% N/A College degree/tech cert < 4 yrs 9 3% 6% N/A 25 9% 25.1 Four-year degree 17 6% 12% N/A 20 7% 9.8 Masters degree or greater 10 3% 6% N/A 16 6% N/A Don t Know 3 1% 1% N/A 0 0% N/A Never Married 105 34% 39% 16.05 100 37% 15.2 Divorced 37 12% 4% 49.61 21 8% 27.6 Legally Separated 0 0% 0% N/A 0 0% N/A Married 159 51% 56% 17.05 144 54% 15.9 Widowed 1 <1% 0% N/A 0 0% N/A Don't Know 7 2% 0% N/A 3 1% N/A 17-24 141 46% 37% 23.04 142 53% 20.10 25-29 73 24% 23% 19.05 38 14% 13.70 30-34 43 14% 12% 21.19 35-39 26 8% 12% 12.62 53 20% 12.10 40-44 15 5% 6% N/A 45+ 11 4% 6% N/A 35 13% 15.7 Page 12
Chapter 2 DoD-Wide Results for Completed Suicides Table 2.2 2009 AND 2008 AFMES DEMOGRAPHICS AND SUICIDE RATES (cont.) COMPONENT Count % DoD Total % Rate Count DoD Total % Regular 284 92% 84% 19.80 235 88% 16.9 Reserve 8 3% 6% N/A 12 4% N/A National Guard 17 6% 9% N/A 21 8% 14.4 TOTAL 309 100% 100% 18.50 268 100% Note: Demographic data were obtained from the DMDC with assistance from the AFMES and reflect suicide events from 1/1/2008 through 12/31/2009 as of 4/1/2010. Total % column reflects proportion of individuals with the demographic characteristic in the combined Services' Active Duty and Activated Reserve and National Guard Forces. * Age bands reported in 2008 DoDSER Annual Report were collapsed into 30-39 and 40+ age groups. Rate Page 13
Chapter 2 DoD-Wide Results for Completed Suicides Table 2.3 2009 DMDC DEMOGRAPHICS BY SERVICE GENDER RACE RANK EDUCATION AIR FORCE ARMY MARINE CORPS NAVY Count % Total AF % Count % Total Army % Count % Total USMC % Count % Total Navy % Male 44 96% 80% 159 97% 86% 52 100% 94% 45 96% 84% Female 2 4% 20% 5 3% 14% 0 0% 6% 2 4% 16% American Indian/Alaskan Native 2 4% 1% 5 3% 1% 0 0% 1% 3 7% 4% Asian/Pacific Islander 2 4% 4% 10 6% 3% 1 2% 3% 2 4% 7% Black/African American 5 11% 14% 19 12% 19% 3 6% 10% 6 13% 18% White/Caucasian 35 76% 74% 130 79% 71% 48 92% 78% 34 72% 63% Other/DK 2 4% 7% 0 0% 5% 0 0% 7% 2 4% 7% Unknown Enlisted 0 0% <1% 2 1% 0% 0 0% 0% 1 2% <1% E1-E4 21 46% 34% 94 57% 42% 39 75% 60% 13 28% 38% E5-E9 20 43% 47% 51 31% 40% 11 21% 29% 30 64% 46% Officer 5 11% 20% 15 9% 13% 1 2% 9% 2 4% 16% Warrant Officer 0 0% 0% 2 1% 3% 1 2% 1% 1 2% <1% Below HS 0 0% <1% 2 1% 1% 0 0% <1% 0 0% 1% GED 0 0% <1% 34 21% 10% 7 13% 4% 3 7% 3% HS graduate 35 76% 55% 96 59% 57% 42 81% 83% 35 76% 70% Some College/tech, no degree 1 2% 5% 11 7% 7% 2 4% 1% 2 4% 2% College degree/tech cert < 4 yrs 4 9% 15% 3 2% 4% 0 0% 2% 2 4% 4% Four-year degree 1 2% 14% 12 7% 13% 1 2% 9% 3 6% 12% Masters degree or greater 5 11% 11% 4 2% 6% 0 0% 2% 1 2% 4% Page 14
Chapter 2 DoD-Wide Results for Completed Suicides Table 2.3 2009 DMDC DEMOGRAPHICS BY SERVICE MARITAL STATUS (cont.) AIR FORCE ARMY MARINE CORPS NAVY Count % Total AF % Count % Total Army % Count % Total USMC % Count % Total Navy % Don t Know 0 0% 1% 2 1% 1% 0 0% <1% 1 2% 3% Never Married 14 30% 33% 58 35% 36% 25 48% 50% 8 17% 45% Divorced 6 13% 7% 22 13% 6% 5 10% 1% 4 9% <1% Legally Separated 0 0% <1% 0 0% <1% 0 0% <1% 0 0% <1% Married 26 57% 60% 83 51% 57% 22 42% 46% 28 60% 55% Widowed 0 0% <1% 1 1% <1% 0 0% <1% 0 0% <1% Don't Know 0 0% <1% 0 0% <1% 0 0% <1% 7 15% <1% 17-24 17 37% 30% 71 43% 33% 40 77% 60% 13 28% 36% 25-29 11 24% 24% 49 30% 23% 5 10% 20% 8 17% 23% AGE 30-34 8 17% 13% 19 12% 12% 3 6% 9% 13 28% 14% 35-39 2 4% 14% 14 9% 13% 3 6% 7% 7 15% 13% 40-44 4 9% 8% 9 5% 6% 0 0% 3% 2 4% 7% 45+ 4 9% 7% 2 1% 7% 1 2% 1% 4 9% 5% Regular 41 89% 88% 147 90% 75% 51 98% 94% 45 96% 93% COMPONENT Reserve 3 7% 3% 3 2% 8% 1 2% 6% 2 4% 7% National Guard 2 4% 8% 14 9% 17% 0 0% 0% 0 0% 0% TOTAL 46 100% 100% 164 100% 100.0 52 100% 100% 47 100% 100% Note: Demographic data were obtained from the DMDC with assistance from the AFMES and reflect suicide events from 1/1/2008 through 12/31/2009 as of 4/1/2010. Service total percentages reflect the proportion of individuals with the demographic characteristic in the entire Service's Active Duty and Activated Reserve and National Guard Forces. Page 15
Chapter 2 DoD-Wide Results for Completed Suicides Event Setting Table 2.4 indicates the countries in which the suicides occurred. The AFMES reported 33 OIF suicides and 10 OEF suicides as of 1 April 2010. DoDSER data provides a description of the event country, although DoDSERs were not received for all suicides, as noted above (DoDSER Submissions). The majority of suicides occurred in the United States (79%, n=234), followed by Iraq (10%, n=31), Europe (3%, n=8), Afghanistan (2%, n=7), and Korea (2%, n=7). Other responses included Greece, Japan, Puerto Rico, and shipside. Table 2.4 2009 AND 2008 DoDSER EVENT COUNTRY EVENT COUNTRY United States 234 79% 192 79% Note: Data differs from AFMES OEF/OIF counts due to missing DoDSERs. Iraq 31 10% 31 13% Afghanistan 7 2% 7 3% Kuwait 1 <1% 1 <1% Korea 7 2% 0 0% Europe 8 3% 5 2% Canada 2 <1% 0 0% Other 6 2% 0 0% Don't Know 1 <1% 7 3% Table 2.5 shows the settings where the suicides occurred. Suicides occurred most in the decedents personal residences, including their military residences (60%, n=178). Eight percent (n=24) occurred at the residence of a friend or family member and 6% (n=17) occurred at work or job sites. Other settings ranged from outdoor locations to other residences and hotels. Table 2.5 2009 AND 2008 DoDSER EVENT SETTING EVENT SETTING Residence (own) or barracks 178 60% 138 57% Residence of friend or family 24 8% 18 7% Work/jobsite 17 6% 22 9% Automobile (away from residence) 16 5% 16 7% Inpatient medical facility 0 0% 1 <1% Other 62 21% 48 20% Page 16
Chapter 2 DoD-Wide Results for Completed Suicides Event Method Figure 2.1 and Table 2.6 display the methods decedents used to die by suicide in 2009. These data were cross checked with the AFMES data for quality control purposes. Military firearms were used more by decedents in the Army and Marine Corps than in the Air Force and Navy. 100 90 80 70 Percentage 60 50 40 30 20 10 11% 19% 29% 7% 54% 40% 39% 31% 31% 24% 17% 21% 17% 20% 10% 30% 0 Firearm, military issue Firearm, non-military issue Hanging Other Air Force Army Marine Corps Navy Figure 2.1 2009 DoDSER SUICIDE METHODS Non-military firearms were the most reported method for completed suicides for all Services (DoD Total = 41%, n=121). Military firearms were used in 18% (n=52) of suicides. Twenty-four percent (n=70) of suicides were completed by hanging, strangulation or suffocation. Other suicide methods included vehicle exhaust (4%, n=11), jumping (2%, n=5), overdose (3%, n=10 for drugs; <1%, n=1 for alcohol), use of a sharp or blunt object (2%, n=7), and lying in front of a moving object (1%, n=2). 1 Table 2.6 2009 AND 2008 DoDSER EVENT METHOD EVENT METHOD Drugs 10 3% 11 5% Alcohol 1 <1% 1 <1% Gas, vehicle exhaust 11 4% 6 2% Gas, utility (or other) 5 2% 1 <1% 1 4% reported other (n=12), and 2% reported don t know (n=6). Page 17
Chapter 2 DoD-Wide Results for Completed Suicides Table 2.6 2009 AND 2008 DoDSER EVENT METHOD (cont.) Hanging 70 24% 51 21% Drowning 0 0% 1 <1% Firearm, military issue 52 18% 51 21% Firearm, non-military issue 121 41% 102 42% Fire, steam, etc. 0 0% 1 <1% Sharp or blunt object 7 2% 2 1% Jumping from high place 5 2% 3 1% Lying in front of moving object 2 1% 1 <1% Crashing a motor vehicle 0 0% 1 <1% Other 12 4% 4 2% Don't Know 1 <1% 7 3% Substance Use during the Event Twenty-two percent (n=66) of submitted DoDSERs in 2009 identified that alcohol was used during the suicide, and 6% (n=19) were reported to have used drugs (Table 2.7) 2. Nine decedents reportedly used both drugs and alcohol during the suicide. Three percent of the individuals with reported drug-use represented use without overdose of over-the-counter medication (n=5) or prescription medication (n=3). These data are likely underestimates, as a significant number of respondents did not have access to information about decedents substance use, presumably because autopsy results were not available at the time of the DoDSER submission. The rate of don t know responses suggests that DoDSER respondents may need access to autopsy results. After excluding don t know responses in order to calculate a valid percentage, 43% of DoDSERs reported that alcohol or drugs had been used during the suicide. Table 2.7 2009 AND 2008 DoDSER SUBSTANCE(S) USED DURING EVENT ALCOHOL USED Yes 66 22% 55 23% No 115 39% 95 39% Don't Know 116 39% 93 38% 2 The meaning of this response is ambiguous, as the DoDSER item does not differentiate between appropriate therapeutic drug use and drug abuse. Because of the wording of the question ( During the event, were drugs used? ), these cases were included in the numbers reported above. Page 18
Chapter 2 DoD-Wide Results for Completed Suicides Table 2.7 2009 AND 2008 DoDSER SUBSTANCE(S) USED DURING EVENT (cont.) ANY DRUGS USED Yes 19 6% 17 7% No 140 47% 122 50% Don't Know 138 46% 104 43% Illegal drugs Overdose 0 0% 1 <1% Used, no overdose 2 1% 0 0% Were not used 157 53% 131 54% Don t Know 138 46% 111 46% Prescription drugs Overdose 8 3% 11 5% Used, no overdose 3 1% 4 2% Were not used 148 50% 123 51% Don t Know 138 46% 105 43% OTC drugs Overdose 2 1% 5 2% Used, no overdose 5 2% 2 1% Were not used 152 51% 126 52% Don t Know 138 46% 110 45% BOTH ALCOHOL AND DRUGS USED Yes 9 3% 6 2% No 147 49% 131 54% Don't Know 141 47% 106 44% Additional Event Information The information in this section includes data on whether the Service Member intended to die and whether the decedent communicated potential for self-harm. Additional items pertain to evidence of death-risk gambling such as Russian roulette or walking railroad tracks, planned or premeditated acts, and whether suicide events were performed in areas or under circumstances in which the behavior was likely to be observed. There was evidence of intent to die for 76% (n=226) of suicides. One hundred seventeen suicides were planned or premeditated and most took place where it was unlikely that others could observe or intervene (69%, n=204). A suicide note was reported to have been found for 25% (n=74) of suicides. (Table 2.8) Page 19
Chapter 2 DoD-Wide Results for Completed Suicides Table 2.8 2009 AND 2008 DoDSER OTHER EVENT INFORMATION INTENDED TO DIE Yes 226 76% 171 70% No 16 5% 15 6% Don't Know 55 19% 57 23% DEATH RISK GAMBLING Yes 4 1% 5 2% No 252 85% 170 70% Don't Know 41 14% 68 28% PLANNED/PREMEDITATED Yes 117 39% 92 38% No 86 29% 65 27% Don't Know 94 32% 86 35% OBSERVABLE Yes 61 21% 47 19% No 204 69% 143 59% Don't Know 32 11% 53 22% SUICIDE NOTE LEFT Yes 74 25% 55 23% No 160 54% 112 46% Don't Know 63 21% 76 31% Communication of Intent Many Service Members who died by suicide in 2009 were reported to have communicated to someone their potential for self-harm, as shown in Figure 2.2. Figure 2.2 2009 COMMUNICATION OF POTENTIAL FOR SELF-HARM Page 20
Chapter 2 DoD-Wide Results for Completed Suicides DoDSER respondents indicate the types of individuals with whom decedents communicate intent to suicide when known. Most decedents had no known history of communicating their potential for selfharm before taking their lives. As displayed in Table 2.9, 28% (n=83) had communicated their potential for self-harm before dying by suicide, and at least 30 Service Members who died by suicide (10%) reported this potential to multiple categories of people (Table 2.10). Whether individuals communicated their potential to harm themselves was not known for the majority of individuals (72%, n=214). As demonstrated in Table 2.11, of the 83 decedents known to have communicated their potential for selfharm, the majority (57%, n=47) communicated the message verbally. Service Members most commonly shared their potential for self-harm with spouses, friends and others, 3 (Table 2.10) which may be informative for suicide prevention efforts. Table 2.9 2009 AND 2008 DoDSER NUMBER OF TYPES OF RECIPIENTS OF COMMUNICATED INTENT NUMBER OF TYPES OF RECIPIENTS OF COMMUNICATED INTENT 0 214 72% 168 69% 1 53 18% 55 23% 2 21 7% 15 6% 3 5 2% 5 2% 4 3 1% 0 0% 5 1 <1% 0 0% Note: The DoDSER asks respondents whether the potential for self-harm was communicated to a friend, spouse, or other categories. If a decedent communicated their potential for self-harm to multiple friends, the DoDSER item would not capture that. Table 2.10 2009 AND 2008 DoDSER RECIPIENTS OF COMMUNICATED INTENT COMMUNICATION Friend 28 9% 20 8% Behavioral Health Staff 16 5% 11 5% Supervisor 11 4% 7 3% Spouse 38 13% 29 12% Chaplain 4 1% 4 2% Other 30 10% 29 12% Made Multiple Communication 30 10% 20 8% 3 The category other includes a variety of co-workers and non-spousal family members. Page 21
Chapter 2 DoD-Wide Results for Completed Suicides Table 2.11 2009 AND 2008 DoDSER MODE OF COMMUNICATED INTENT MODE OF COMMUNICATED INTENT Verbal Only 47 16% 44 18% Written Only 7 2% 3 1% Other 18 6% 9 4% Multiple Modes 12 4% 11 5% Note: Multiple Modes includes a combination of verbal, written, or other mode of communicating intent to suicide. Contextual Factors This section describes DoDSER data that pertains to contextual factors such as the home and duty environments. Home Environment As can be seen in Table 2.12, Service Members who died by suicide most frequently lived in off-base family housing (46%, n=137). An additional 31% (n=92) lived in barracks or other shared military housing. Five percent (n=15) of decedents lived in bachelor enlisted quarters or bachelor officer quarters and 5% (n=14) lived in on-base family housing. Eight percent (n=24) lived in other housing and 1% (n=3) were stationed on ships. Thirty-four percent (n= 102) of decedents lived alone. Thirty-seven percent (n=111) reportedly had minor children (the majority of whom did not live with their children at the time of the event). Firearms were present in the home or immediate environment for 49% (n=146) of decedents. Table 2.12 2009 AND 2008 DoDSER HOME ENVIRONMENT RESIDENCE AT TIME OF EVENT Shared military living environment 92 31% 70 29% MARRIED SERVICE MEMBER RESIDENCE Bachelor quarters 15 5% 13 5% On-base family housing 14 5% 11 5% Owned or leased apartment or house 137 46% 95 39% Ship 3 1% 5 2% Other 24 8% 18 7% Don't Know 12 4% 31 13% Resides with spouse 70 24% 53 22% Separated due to relationship issues 29 10% 31 13% Apart for other reasons/deployed 35 12% 23 9% Don't Know 13 4% 12 5% Unmarried at time of event 150 51% 124 51% Page 22
Chapter 2 DoD-Wide Results for Completed Suicides Table 2.12 2009 AND 2008 DoDSER HOME ENVIRONMENT (cont.) RESIDED ALONE Yes 102 34% 59 24% No 168 57% 147 60% Don't Know 27 9% 37 15% HAD MINOR CHILDREN Yes 111 37% 79 33% No 158 53% 116 48% Don't Know 28 9% 48 20% CHILDREN RESIDED WITH Yes 51 17% 33 14% No 55 19% 43 18% Don't Know 5 2% 3 1% No Children 186 63% 164 67% HAD ACCESS TO FIREARM Yes 146 49% 133 55% No 79 27% 36 15% Don't Know 72 24% 74 30% Duty Environment As shown in Table 2.13, Garrison or with Permanent Command was the most frequently reported duty environment for decedents (41%, n=123), followed by leave (10%, n=31). Additional information regarding deployment status is provided in each Service chapter. Table 2.13 2009 AND 2008 DoDSER DUTY ENVIRONMENT DUTY ENVIRONMENT Garrison 123 41% 90 37% Psych Hosp 1 <1% 1 <1% Leave 31 10% 26 11% Medical Hold 5 2% 5 2% TDY 7 2% 4 2% Evacuation Chain 0 0% 1 <1% AWOL 15 5% 7 3% Under Command Obs 1 <1% 1 <1% Other 26 9% 14 6% Training 12 4% 8 3% Multiple Duty Environments Provided 19 6% 8 3% Note: Duty environment was not required for all DoDSERs. As such, percentages do not add to 100%. Page 23
Chapter 2 DoD-Wide Results for Completed Suicides Suicide Completions by Month Figure 2.3 and Table 2.14 displays suicide counts by month for the combined Services. 40 Count 35 30 25 20 15 10 27 22 33 15 19 18 24 21 29 24 20 19 29 23 32 21 20 20 20 16 21 26 22 19 2009 2008 5 0 Figure 2.3 2009 AND 2008 DoDSER SUICIDE COMPLETIONS BY MONTH Table 2.14 2009 AND 2008 DoDSER SUICIDE EVENTS BY MONTH MONTH January 27 9% 22 9% February 33 11% 15 6% March 19 6% 18 7% April 24 8% 21 9% May 29 10% 20 8% June 24 8% 19 8% July 29 10% 23 9% August 21 7% 20 8% September 16 5% 20 8% October 32 11% 20 8% November 21 7% 26 11% December 22 7% 19 8% Page 24
Chapter 2 DoD-Wide Results for Completed Suicides Clinical/Symptom Factors The DoDSER also captures detailed information on clinical, behavioral, and symptom factors that may be associated with subsequent suicidal behavior. These factors include data on prior self-harm, previous diagnoses of behavioral health disorders and behavioral health issues, and relevant treatment histories, including prescribed medication. Prior Self-Injury As can be seen in Table 2.15, prior self-injury was not reported for the majority of suicide decedents (58%, n=173 ). Ten percent (n=30) of individuals with a history of prior self-injury had one known prior incidence of self-injury. Seven percent (n=21) had a known history of more than one event. Data on whether the latest self-injury was similar to prior self-injuries as well as the time between previous and latest event are also included in Table 2.15. Table 2.15 2009 AND 2008 DoDSER PRIOR SELF-INJURY HX PRIOR SELF-INJURY Yes 51 17% 33 14% Within 30 days 12 4% 6 2% Within 90 days (inclusive)* 23 8% 12 5% No 173 58% 111 46% Don't Know 73 25% 99 41% Number prior self-injuries One prior event 30 10% --- --- More than one prior event 21 7% --- --- N/A 246 83% --- --- Event similar to prior self-injury Yes 9 3% 6 2% No 30 10% 21 9% Don't Know 12 4% 6 2% N/A 246 83% 210 86% Note: Number of prior self-injuries not available for 2008. *Data presented for Within 90 days includes all cases that reported the event Within 30 days. Page 25
Chapter 2 DoD-Wide Results for Completed Suicides Behavioral Health Disorders Figure 2.4 shows the behavioral health disorders reported for decedents in 2009. Percentage 100 90 80 70 60 50 40 30 20 10 0 25% 11% 18% 6% 21% 17% 5% 1% Figure 2.4 2009 DoDSER BEHAVIORAL HEALTH DISORDERS Forty-two percent (n=126) of decedents had a history of at least one behavioral health disorder (Table 2.16). Twenty-five percent (n=75) of decedents had been diagnosed with a mood disorder, including major depression (n=34), dysthymic disorder (n=5), bipolar disorder (n=2), and other mood disorders (n=15) (Table 2.17). Eighteen percent (n=53) had been diagnosed with an anxiety disorder, including with posttraumatic stress disorder (PTSD), 6% (n=19) (Table 2.18). Three had been diagnosed with a psychotic disorder (one diagnosed within 30 days of the suicide) (Table 2.19). Five percent (n=15) of decedents had been diagnosed with a personality disorder, and 22% (n=64) had a history of a substance abuse disorder. Table 2.16 2009 AND 2008 DoDSER COMORBIDITY RATES NUMBER OF BEHAVIORAL HEALTH DIAGNOSES No DX 171 58% 164 67% 1 DX 66 22% 55 23% 2 DX 37 12% 11 5% 3 DX 13 4% 10 4% 4 or more DX 10 3% 3 1% Page 26
Chapter 2 DoD-Wide Results for Completed Suicides Table 2.17 2009 AND 2008 DoDSER MOOD DISORDERS DX W/ MOOD DISORDER Yes 75 25% 46 19% No 178 60% 142 58% Don't Know 44 15% 55 23% Bipolar disorder Yes 2 1% 2 1% No 239 80% 175 72% Don't Know 56 19% 66 27% Major depression Yes 34 11% 13 5% No 211 71% 167 69% Don't Know 52 18% 63 26% Dysthymic disorder Yes 5 2% 2 1% No 234 79% 176 72% Don't Know 58 20% 65 27% Other mood disorder Yes 15 5% 21 9% No 226 76% 156 64% Don't Know 56 19% 66 27% Unspecified mood disorder Yes 9 3% 6 2% No 244 82% 182 75% Don't Know 44 15% 55 23% Multiple mood DX Yes 10 3% 2 1% No 243 82% 186 77% Don't Know 44 15% 55 23% Table 2.18 2009 AND 2008 DoDSER ANXIETY DISORDERS DX W/ ANXIETY DISORDER Yes 53 18% 25 10% No 196 66% 165 68% Don't Know 48 16% 53 22% PTSD Yes 19 6% 6 2% No 225 76% 176 72% Don't Know 53 18% 61 25% Panic disorder Yes 0 0% 1 <1% No 243 82% 179 74% Don't Know 54 18% 63 26% Page 27
Chapter 2 DoD-Wide Results for Completed Suicides Table 2.18 2009 AND 2008 DoDSER ANXIETY DISORDERS (cont.) Generalized anxiety disorder Yes 3 1% 1 <1% No 241 81% 180 74% Don't Know 53 18% 62 26% Acute stress disorder Yes 0 0% 1 0% No 243 82% 181 74% Don't Know 54 18% 61 25% Other anxiety disorder Yes 15 5% 6 2% No 229 77% 174 72% Don't Know 53 18% 63 26% Unspecified anxiety DX Yes 5 2% 4 2% No 244 82% 186 77% Don't Know 48 16% 53 22% Multiple anxiety DX Yes 11 4% 6 2% No 238 80% 184 76% Don't Know 48 16% 53 22% Table 2.19 2009 AND 2008 DoDSER OTHER BEHAVIORAL HEALTH DISORDERS DX W/PERSONALITY DISORDER Yes 15 5% 12 5% No 230 77% 175 72% Don't Know 52 18% 56 23% DX W/PSYCHOTIC DISORDER Yes 3 1% 2 1% No 245 82% 187 77% Don't Know 49 16% 54 22% HX SUBSTANCE ABUSE Yes 64 22% 49 20% No 170 57% 134 55% Don't Know 63 21% 60 25% Page 28
Chapter 2 DoD-Wide Results for Completed Suicides Treatment Figure 2.5 displays the history of decedents visits to treatment programs and clinics prior to dying by suicide. *Data presented for "Within 90 days" includes all cases that reported the event "Within 30 days." Percentage 100 90 80 70 60 50 40 30 20 10 0 36% 22% 48% 25% 8% 8% 11% 9% 6% 2% 1% 3% Military Treatment Facility Outpatient Mental Health Chaplain Substance Abuse Services Inpatient Mental Health Family Advocacy Program Within 30 Days Within 90 Days (inclusive)* Figure 2.5 2009 DoDSER TREATMENT HISTORY Table 2.20 shows the number of Service Members who had ever been seen in a program or clinic, had been seen within 30 days and 90 days of suicide. DoDSER respondents were instructed to select all categories that applied, thus they are not mutually exclusive. A total of 175 (59%) of decedents were seen at military treatment facilities (MTFs) within the year preceding suicide. Of these, 12% (n=36) of decedents had been seen in MTFs within 90 days of the suicide and 36% (n=107) within 30 days. Twenty-one percent (n=63) had been treated in outpatient behavioral health facilities within 30 days of the suicide, and an additional 4% (n=10) within 90 days. Table 2.20 also summarizes information about visits to the other programs and broadly-defined behavioral health resources (i.e., Chaplain, Family Advocacy Programs, Alcohol and Substance Abuse Services, and Inpatient Behavioral Health Facilities) within 30 and 90 days. Forty-nine percent reportedly received medical, behavioral health, substance abuse, family or chaplaincy services within 30 days of death. Page 29
Chapter 2 DoD-Wide Results for Completed Suicides Table 2.20 2009 AND 2008 DoDSER TREATMENT HISTORY SEEN AT MILITARY TREATMENT Yes 175 59% 126 52% FACILITY Within 30 days 107 36% 71 29% Within 90 days (inclusive)* 143 48% 96 40% No 80 27% 65 27% Don't Know 42 14% 52 21% SUBSTANCE ABUSE SERVICES Yes 49 16% 27 11% Within 30 days 24 8% 10 4% Within 90 days (inclusive)* 26 9% 15 6% No 200 67% 163 67% Don't Know 48 16% 53 22% FAMILY ADVOCACY PROGRAMS Yes 20 7% 15 6% Within 30 days 4 1% 8 3% Within 90 days (inclusive)* 9 3% 9 4% No 211 71% 169 70% Don't Know 66 22% 59 24% CHAPLAIN SERVICES Yes 38 13% 34 14% Within 30 days 24 8% 18 7% Within 90 days (inclusive)* 32 11% 25 10% No 125 42% 103 42% Don't Know 134 45% 106 44% OUTPATIENT BEHAVIORAL HEALTH Yes 121 41% 80 33% Within 30 days 63 21% 41 17% Within 90 days (inclusive)* 73 25% 54 22% No 138 46% 124 51% Don't Know 38 13% 39 16% INPATIENT BEHAVIORAL HEALTH Yes 45 15% 25 10% Within 30 days 7 2% 10 4% Within 90 days (inclusive)* 19 6% 13 5% No 207 70% 165 68% Don't Know 45 15% 53 22% HX PHYSICAL HEALTH PROBLEM Yes 64 22% 49 20% Within 30 days 37 13% 27 11% Within 90 days (inclusive)* 44 15% 40 16% No 166 56% 136 56% Don't Know 67 23% 58 24% Page 30
Chapter 2 DoD-Wide Results for Completed Suicides Table 2.21 summarizes decedents use of prescription psychotropic medication. Similar to 2008, history of psychotropic medication use was reported for 24% (n = 71) of decedents. Twenty-one percent (n = 62) had taken antidepressants; 9% (n = 27) antianxiety medications; 5% (n = 15) anti-psychotics; and 2% (n = 7) anticonvulsants. Table 2.21 2009 AND 2008 DoDSER PSYCHOTROPIC MEDICATION USE TAKEN PSYCHOTROPIC MEDS Yes 71 24% 51 21% No 162 55% 127 52% Don't Know 64 22% 65 27% Antidepressants Yes 62 21% 43 18% No 170 57% 131 54% Don't Know 65 22% 69 28% Antianxiety Yes 27 9% 16 7% No 202 68% 157 65% Don't Know 68 23% 70 29% Antimanics Yes 2 1% 2 1% No 227 76% 168 69% Don't Know 68 23% 73 30% Anticonvulsants Yes 7 2% 5 2% No 223 75% 165 68% Don't Know 67 23% 73 30% Antipsychotics Yes 15 5% 6 2% No 215 72% 165 68% Don't Know 67 23% 72 30% Historical/Developmental Factors DoDSER data are collected on historical or developmental factors that precede a suicide event. These data include information about family histories and interpersonal relationships, legal, financial and administrative difficulties, and reports of prior abuse. Page 31
Chapter 2 DoD-Wide Results for Completed Suicides Family and Relationship History Figure 2.6 shows the percentages of decedents who experienced failed intimate and non-intimate relationships prior to suicide. 100 90 80 70 Percentage 60 50 40 30 20 10 51% 27% 26% 24% 13% 8% 48% 39% Yes Within 30 days No Don't Know 0 HX Failed Intimate Relationship HX Failed Other Relationship Figure 2.6 2009 HISTORY OF FAILED RELATIONSHIPS Table 2.22 provides data regarding relationship history factors. Failed marital or intimate relationships were reported for 51% (n=150) of Service Members who died by suicide. In addition, other failed relationships (non-intimate) were reported for 13% (n=39) of suicide decedents. Fifty-three percent (n=158) of decedents were reported to have experienced failure of either an intimate or non-intimate relationship prior to death. Similar to 2008, most of these failed relationships occurred shortly before the suicide. Twenty-seven percent (n=81) of decedents had a reported intimate relationship failure within 30 days of the suicide. Other failed relationships occurred within 30 days of the events for 8% (n=24) of suicides. Page 32
Chapter 2 DoD-Wide Results for Completed Suicides Table 2.22 2009 AND 2008 DoDSER RELATIONSHIP HISTORY HX FAILED INTIMATE RELATIONSHIP Yes 150 51% 127 52% Within 30 days 81 27% 80 33% Within 90 days (inclusive)* 102 34% 105 43% No 76 26% 58 24% Don't Know 71 24% 58 24% HX FAILED OTHER RELATIONSHIP Yes 39 13% 35 14% Within 30 days 24 8% 19 8% Within 90 days (inclusive)* 27 9% 26 11% No 142 48% 106 44% Don't Know 116 39% 102 42% HX ANY FAILED RELATIONSHIP Yes 158 53% 137 56% Within 30 days 88 30% 88 36% Within 90 days (inclusive)* 109 37% 112 46% No 72 24% 50 21% Don't Know 67 23% 56 23% As indicated in Table 2.23, there was a reported history of recent spousal or family death, other than by suicide, for 6% (n=18) of suicides (n=6 within three months). There was also a reported history of a chronic spousal or family severe illness for 6% (n=19) of suicides (n=11 within three months). A family history of behavioral health illness or suicide was reported for 15% (n=44) of decedents, with one spousal suicide occurring within 30 days. These rates are probably underestimates because don t know responses were fairly common for all of these risk factors. Table 2.23 2009 AND 2008 DoDSER FAMILY HISTORY HX SPOUSE SUICIDE Yes 1 <1% 1 <1% No 249 84% 177 73% Don't Know 47 16% 65 27% HX FAMILY MEMBER SUICIDE Yes 12 4% 11 5% No 190 64% 119 49% Don't Know 95 32% 113 47% HX FRIEND SUICIDE Yes 5 2% 3 1% No 173 58% 122 50% Don't Know 119 40% 118 49% Page 33
Chapter 2 DoD-Wide Results for Completed Suicides Table 2.23 2009 AND 2008 DoDSER FAMILY HISTORY (cont.) HX DEATH OF FAMILY MEMBER Yes 18 6% 17 7% No 175 59% 117 48% Don't Know 104 35% 109 45% HX DEATH OF FRIEND Yes 9 3% 12 5% No 160 54% 101 42% Don't Know 128 43% 130 53% HX FAMILY ILLNESS Yes 19 6% 12 5% HX FAMILY BEHAVIORAL HEALTH PROBLEMS No 180 61% 110 45% Don't Know 98 33% 121 50% Yes 44 15% 21 9% No 90 30% 46 19% Don't Know 163 55% 176 72% Administrative and Legal History Figure 2.7 shows the percentage of decedents who experienced administrative or legal difficulties prior to suicide. 25 20 HX Article 15 Percentage 15 10 5 7% 7% 6% 5% 3% 3% 2% 10% 9% 10% 8% 5% 6% 4% HX AWOL HX Civil Legal Problems HXAdmin Separation HX Courts Martial HX Medical Board HX Non-Selection 0 Within 30 days Within 90 days Figure 2.7 2009 ADMINISTRATIVE/LEGAL HISTORY A history of Article 15 proceedings were reported for 15% of decedents (n=46) and a history of civil legal problems were reported among 12% of completions (n=36). At some point during their service, 8% of decedents (n=25) were reportedly subjects of administrative separation proceedings and 10% (n=30) Page 34
Chapter 2 DoD-Wide Results for Completed Suicides were subjects of AWOL/desertion proceedings. Further, 6% (n=19) of decedents had a history of courts martial proceedings. Other administrative and legal risk factors were less commonly reported. (Table 2.24) Table 2.24 2009 AND 2008 DoDSER ADMIN/LEGAL HISTORY HX COURTS MARTIAL Yes 19 6% 3 1% No 235 79% 199 82% Don't Know 43 14% 41 17% HX ARTICLE 15 Yes 46 15% 26 11% No 177 60% 92 38% Don't Know 74 25% 125 51% HX ADMIN SEPARATION Yes 25 8% 14 6% No 230 77% 180 74% Don't Know 42 14% 49 20% HX AWOL Yes 30 10% 14 6% No 229 77% 182 75% Don't Know 38 13% 47 19% HX MEDICAL BOARD Yes 24 8% 9 4% No 235 79% 185 76% Don't Know 38 13% 49 20% HX CIVIL LEGAL PROBLEMS Yes 36 12% 32 13% No 194 65% 151 62% Don't Know 67 23% 60 25% HX NON-SELECTION Yes 23 8% 10 4% No 219 74% 155 64% Don't Know 55 19% 78 32% Abuse History Seven percent (n=20) of decedents had a history of physical abuse, 4% (n=13) had a history of sexual abuse, and 7% (n=21) had a history of emotional abuse. Sexual harassment was reported for one suicide in 2009. Abuse in which the decedent was the perpetrator was not frequently indicated, although DoDSERs for 9% (n=26) of decedents reported that they had been alleged or confirmed perpetrators of physical abuse and that 3% (n=10) had been alleged or confirmed perpetrators of sexual abuse. Table 2.25 provides additional 2009 DoDSER abuse history. Page 35
Chapter 2 DoD-Wide Results for Completed Suicides Table 2.25 2009 AND 2008 DoDSER ABUSE HISTORY HX VICTIM PHYSICAL ABUSE Yes 20 7% 10 4% No 176 59% 115 47% Don't Know 101 34% 118 49% HX VICTIM SEXUAL ABUSE Yes 13 4% 6 2% No 183 62% 122 50% Don't Know 101 34% 115 47% HX VICTIM EMOTIONAL ABUSE Yes 21 7% 11 5% No 171 58% 113 47% Don't Know 105 35% 119 49% HX VICTIM SEXUAL HARASSMENT Yes 1 <1% 0 0% No 188 63% 126 52% Don't Know 108 36% 117 48% HX PERPETRATOR PHYSICAL ABUSE Yes 26 9% 13 5% No 173 58% 116 48% Don't Know 98 33% 114 47% HX PERPETRATOR SEXUAL ABUSE Yes 10 3% 9 4% No 183 62% 124 51% Don't Know 104 35% 110 45% HX PERPETRATOR EMOTIONAL ABUSE Yes 9 3% 8 3% HX PERPETRATOR SEXUAL HARASSMENT No 179 60% 122 50% Don't Know 109 37% 113 47% Yes 5 2% 3 1% No 185 62% 129 53% Don't Know 107 36% 111 46% Financial and Workplace Difficulties Excessive debt or bankruptcy was reported for 11% (n=32) of suicides. A history of job problems was reported for 27% (n=81) of decedents. A history of supervisor or co-worker issues was reported for 14% (n=42) of suicides. Additional information related to job or employment difficulties is presented in Table 2.26. Page 36
Chapter 2 DoD-Wide Results for Completed Suicides Table 2.26 2009 AND 2008 DoDSER FINANCIAL AND WORKPLACE DIFFICULTIES EXCESSIVE DEBT/BANKRUPTCY Yes 32 11% 25 10% No 161 54% 125 51% Don't Know 104 35% 93 38% HX JOB LOSS/INSTABILITY Yes 81 27% 44 18% No 151 51% 149 61% Don't Know 65 22% 50 21% HX SUPERVISOR/COWORKER ISSUES Yes 42 14% 26 11% No 179 60% 136 56% Don't Know 76 26% 81 33% HX POOR WORK EVALUATION Yes 50 17% 27 11% No 185 62% 145 60% Don't Know 62 21% 71 29% HX UNIT/WORKPLACE HAZING Yes 5 2% 2 1% No 208 70% 158 65% Don't Know 84 28% 83 34% Deployment Factors The 2009 DoDSER captured detailed information pertaining to the Service Member s most recent three deployments. Data includes deployment location information as well as a history of direct combat operations. Comparisons of Operation Enduring Freedom/Operation Iraqi Freedom (OEF/OIF) suicide events to non-oef/oif suicide events are reported in Chapter 3. Deployment History Table 2.27 summarizes OEF/OIF deployment history information for the most commonly reported deployment locations: Afghanistan, Iraq, and Kuwait. Fifty-one percent of decedents (n=152) had deployed at least once. Iraq was the most common deployment location reported for suicide decedents (37%, n=111), followed by Afghanistan (4%, n=11), and Kuwait (3%, n=9). Seven percent of decedents (n=21) reportedly had histories of multiple deployments to Iraq, Afghanistan, or Kuwait. See the individual Service chapters for additional information on suicide and deployment data. Page 37
Chapter 2 DoD-Wide Results for Completed Suicides Table 2.27 2009 AND 2008 DoDSER EVER DEPLOYED TO OEF/OIF HX DEPLOYMENT OEF/OIF AFGHANISTAN 11 4% 10 4% IRAQ 111 37% 83 34% KUWAIT 9 3% 16 7% MULTIPLE OEF/OIF LOCATIONS 21 7% 3 1% NO HX OEF/OIF DEPLOYMENT 145 49% 131 54% Combat History Seventeen percent (n=51) of decedents had experienced direct combat operations, and 57% of these (n=29) had witnessed casualties (Table 2.28). Thirty-four (67% of those with combat experience) had participated in operations that resulted in combat casualty. Similar to 2008, the percentages of decedents who had experienced combat were generally low. These numbers reflect the response rate based on available data. Table 2.28 2009 AND 2008 DoDSER COMBAT HISTORY COMBAT HISTORY HX DIRECT COMBAT 51 17% 39 16% Combat Resulted in Injuries/Casualties 34 67% 22 56% Injured in Combat 10 20% 8 21% Witnessed in Combat 29 57% 20 51% Saw Dead Bodies in Combat 28 55% 17 44% Killed Others in Combat 12 24% 8 21% NO DIRECT COMBAT HX 246 83% 204 84% Note: Indented items were only asked in cases for which the respondent indicated that the decedent had participated in direct combat. Percentages for these items reflect proportion of those with combat experience. Page 38
Chapter 2 DoD-Wide Results for Completed Suicides Summary This annual statistical report of the DoDSER provides statistics and analyses for DoD suicides that occurred in 2009. Data from 2008 DoDSERs are included for comparisons. The AFMES identified 309 Service Member suicides in 2009 (Air Force = 46; Army = 164; Marine Corps = 52; Navy = 47). A total of 297 DoDSERs were received in 2009 for a DoDSER submission compliance rate of 97% (based on 299 suicides confirmed as of 31 January 2010). Consistent with 2008 DoDSER data, individuals who were Caucasian, under the age of 25, junior enlisted (E1-E4), or had a GED or high school education were at increased risk for suicide relative to demographic comparison groups. Divorced individuals were almost three times more likely to die by suicide than were married persons. Across Services, non-military firearms were the most frequently used method for suicide (41%, n=121). Military firearms were used in 18% (n=52) of suicides with a higher incidence in the Army and Marine Corps than in the Air Force and Navy. Thirteen percent of suicides (n=39) died on deployment in OEF/OIF. Ten percent occurred while Service Members were on leave. Seven percent of Service Members who died by suicide had a history of multiple deployments to Iraq, Afghanistan, or Kuwait. A history of direct combat operations was reported for 17% (n=51) of decedents. Forty-eight percent of decedents (n=143) had been seen at a military treatment facility within three months prior to suicide (36% within 30 days of the suicide). Failed marital or intimate relationships were reported for 51% (n=150) of decedents, and other failed relationships (non-intimate) were reported for 13% (n=39) of decedents. The most common legal problems were Article 15 proceedings (15%) and civil legal problems (12%). Seventeen percent of Service Members who died by suicide had a known history of prior self-injurious behavior. Twenty-eight percent (n=82) had communicated their potential for self-harm prior to dying by suicide. Most decedents (57%) did not have a diagnosed behavioral health disorder reported. A total of 3% of decedents reportedly used both alcohol and drugs during the event. A history of job problems was reported for 27% (n=81) of decedents. Page 39
Chapter 3 DoD-WIDE RESULTS FOR COMPLETED SUICIDES IN OEF/OIF AND NON-OEF/OIF LOCATIONS For calendar year 2009, risk factors for suicide behaviors were reported for events that occurred during Operation Enduring Freedom/Operation Iraqi Freedom (OEF/OIF) deployments and for non-oef/oif events. Of the 43 OEF/OIF 2009 suicides reported by AFMES (as of 1 April 2010), Department of Defense Suicide Event Reports (DoDSERs) were submitted for 39 of the events. Complete DoDSER data tables are presented in this chapter and 2008 data are included for comparison. Although Table 3.1 shows all OEF/OIF suicides for 2009 (n=43), the subsequent tables in this chapter include only decedents for which DoDSERs were received (n=39 for 2008 and 2009). Interpretation of any relative differences between OEF/OIF decedents and others is complicated by the potential for cohort differences. For example, the military population that deploys may differ from the non-deployed cohort (which includes some who will never deploy due to health reasons or other factors). However, this data may be useful for forming hypotheses. Table 3.1 2009 and 2008 SUICIDES IN OEF/OIF AND NON-OEF/OIF EVENTS COMPLETED SUICIDE Event occurred in OEF/OIF 43 14% 41 15% Event occurred in other location 266 86% 225 85% Note: Data provided by AFMES (as of 1 April 2010). Subsequent data tables in Chapter 3 include OEF/OIF events for which there are DoDSERs (n=39). Dispositional/Personal Factors This section reports data that describe internal characteristics or individual behaviors of decedents that may have been associated with or contributed to the suicides. These factors include decedents demographic characteristics, event setting, suicide method, substance use during the event, possible motive and intent to die, and communication of intent with others. Page 40
Chapter 3 DoD-Wide Results for Completed Suicides in OEF/OIF and Non-OEF/OIF Locations Demographics Table 3.2 summarizes 2009 suicide demographic data based on DoDSER data collected on OEF/OIF events and non-oef/oif events. It was not possible to use the DMDC demographic data described in Chapter 2 because the aggregated data received did not identify the OEF/OIF cases. Therefore, it was not possible to calculate suicide rates by demographic characteristics. However, DoDSER data showed that: The majority of suicides were completed by men for both OEF/OIF events (97%, n=38) and non-oef/oif events (97%, n=252). Most OEF/OIF suicides were completed by Caucasians (64%, n=25), followed by African Americans (18%, n=7). This trend was the same for non-oef/oif events. Suicide was more common among persons under age 25 for both of OEF/OIF (59%, n=23) and non-oef/oif events (44%, n=115). Most suicides (72%, n=28) were completed by junior enlisted (E1-E4) personnel followed by middle to senior (E5-E9) enlisted personnel (23%, n=9). This trend was identical for non-oef/oif events. The highest level of education for the majority of decedents in 2009 was high school graduate for both OEF/OIF events (62%, n=24) and non- OEF/OIF events (46%, n=118). Approximately half of the suicides (51%, n=20) were completed by persons who were never married followed by married persons (36%, n=14) for OEF/OIF events, whereas for non-oef/oif suicides, approximately half (51%, n=133) were completed by married persons followed by never married persons (33%, n=85). Consistent with non-oef/oif events, the majority of suicides were completed by Regular Active Duty personnel (90%, n=35). Demographic base rates for the OEF/OIF population would be helpful to interpret relative differences noted. For example, it is possible that the deployed population is comprised of a higher rate of young, junior enlisted Service Members than the general military population. Page 41
Chapter 3 DoD-Wide Results for Completed Suicides in OEF/OIF and Non-OEF/OIF Locations Table 3.2 2009 AND 2008 DoDSER DEMOGRAPHICS FOR OEF/OIF AND NON-OEF/OIF EVENTS OEF/OIF Other OEF/OIF Other GENDER Male 38 97% 252 97% 35 90% 196 96% Female 1 3% 7 3% 4 10% 9 4% RACE Asian/Pacific Islander 1 3% 9 3% 2 5% 7 3% African American 7 18% 25 10% 6 16% 22 11% Caucasian 25 64% 169 65% 23 61% 140 69% Hispanic 1 3% 9 3% 0 0% 7 3% Other/Don t Know/Missing 5 13% 47 18% 7 18% 27 13% AGE RANGE Under 25 23 59% 115 44% 21 54% 100 49% 25-29 10 26% 62 24% 8 21% 41 20% 30-39 4 10% 60 23% 6 15% 41 20% 40 + 2 5% 22 8% 4 10% 23 11% RANK E1-E4 28 72% 137 53% 28 72% 103 50% E5-E9 9 23% 99 38% 7 18% 82 40% Officer 2 5% 18 7% 4 10% 16 8% Warrant Officer 0 0% 3 1% 0 0% 2 1% Cadet/Midshipman 0 0% 2 1% 0 0% 1 <1% Does Not Apply 0 0% 0 0% 0 0% 1 <1% COMPONENT Regular 35 90% 245 95% 35 90% 193 94% Reserve 1 3% 6 2% 1 3% 5 2% National Guard 3 8% 7 3% 3 8% 7 3% Other 0 0% 1 <1% 0 0% 0 0% Page 42
Chapter 3 DoD-Wide Results for Completed Suicides in OEF/OIF and Non-OEF/OIF Locations Table 3.2 2009 AND 2008 DoDSER DEMOGRAPHICS FOR OEF/OIF AND NON-OEF/OIF EVENTS (cont.) OEF/OIF Other OEF/OIF Other EDUCATION Some high school, did not graduate 0 0% 2 1% 0 0% 0 0% GED 4 10% 11 4% 2 5% 5 2% High school graduate 24 62% 118 46% 13 33% 76 37% Some college or technical school, no 4 10% 45 17% 5 13% 16 8% degree or certificate College degree of less than four years or 1 3% 7 3% 0 0% 5 2% technical school certificate Four-year college degree 2 5% 10 4% 1 3% 15 7% Master s degree or greater 1 3% 9 3% 2 5% 5 2% Don t Know 3 8% 57 22% 16 41% 83 40% MARITAL STATUS Never Married 20 51% 85 33% 20 51% 68 33% Married 14 36% 133 51% 16 41% 103 50% Legally Separated 1 3% 5 2% 0 0% 8 4% Divorced 4 10% 28 11% 0 0% 15 7% Widowed 0 0% 1 <1% 0 0% 0 0% Don t Know 0 0% 7 3% 3 8% 11 5% Page 43
Chapter 3 DoD-Wide Results for Completed Suicides in OEF/OIF and Non-OEF/OIF Locations Event Setting Table 3.3 shows the settings in which the suicides occurred. Similar to non-oef/oif events, the majority of suicides occurred in decedents residences, including military residences (62%, n=24). Thirteen percent (n=5) of OEF/OIF suicides occurred at places of work or job sites compared to 5% (n=12) for non- OEF/OIF suicides. Twenty-six percent (n=10) occurred at other settings for OEF/OIF events and 20% (n=52) for non-oef/oif events. Table 3.3 2009 AND 2008 DoDSER EVENT SETTING FOR OEF/OIF AND NON-OEF/OIF EVENTS OEF/OIF Other OEF/OIF Other EVENT SETTING Residence (own) or barracks 24 62% 154 60% 20 51% 118 58% Residence of friend or family 0 0% 24 9% 0 0% 18 9% Work/jobsite 5 13% 12 5% 11 28% 11 5% Automobile (away from residence) 0 0% 16 6% 0 0% 16 8% Inpatient medical facility 0 0% 0 0% 0 0% 1 <1% Other 10 26% 52 20% 8 21% 40 20% Page 44
Chapter 3 DoD-Wide Results for Completed Suicides in OEF/OIF and Non-OEF/OIF Locations Event Method Figure 3.1 shows the methods decedents chose for suicide in 2009. 100 97% 90 80 70 Percentage 60 50 40 30 20 46% 26% 22% OEF/OIF Other 10 0 6% Firearm, military issue <1% <1% 3% Firearm, nonmilitary issue Hanging Other Figure 3.1 2009 METHODS FOR OEF/OIF AND OTHER SUICIDES Page 45
Chapter 3 DoD-Wide Results for Completed Suicides in OEF/OIF and Non-OEF/OIF Locations Methods of suicide for OEF/OIF events in 2009 and 2008 are displayed in Table 3.4. Military firearms were the most commonly reported method for OEF/OIF suicides (97%, n=38). For non-oef/oif suicides, the most commonly reported method was non-military issue firearm 47% (n=121), followed by hanging 27% (n=70). Table 3.4 2009 AND 2008 DoDSER EVENT METHOD FOR OEF/OIF AND NON-OEF/OIF EVENTS OEF/OIF Other OEF/OIF Other EVENT METHOD Drugs 0 0% 10 4% 2 5% 9 4% Alcohol 0 0% 1 <1% 0 0% 1 <1% Gas, vehicle exhaust 0 0% 11 4% 0 0% 6 3% Gas, utility (or other) 0 0% 5 2% 0 0% 1 0% Hanging 0 0% 70 27% 0 0% 51 25% Drowning 0 0% 0 0% 0 0% 1 <1% Firearm, military issue 38 97% 14 5% 37 95% 14 7% Firearm, non-military issue 0 0% 121 47% 0 0% 102 50% Fire, steam, etc. 0 0% 0 0% 0 0% 1 <1% Sharp or blunt object 0 0% 7 3% 0 0% 2 1% Jumping from high place 0 0% 5 2% 0 0% 3 1% Lying in front of moving object 0 0% 2 1% 0 0% 1 <1% Crashing a motor vehicle 0 0% 0 0% 0 0% 1 <1% Other 1 3% 11 4% 0 0% 4 2% Don't Know 0 0% 1 <1% 0 0% 7 3% Page 46
Chapter 3 DoD-Wide Results for Completed Suicides in OEF/OIF and Non-OEF/OIF Locations Substance Use during the Event Three percent (n=1) of submitted DoDSERs for 2009 indicated that drugs were used during events that took place in OEF/OIF, compared to 7% (n=18) for non-oef/oif events (Table 3.5). The majority of DoDSERs had a don t know response. Percentages of yes responses are likely an underestimate, as a significant number of cases did not have access to information about substance use, presumably because autopsy results were not available at the time of the DoDSER submission. Table 3.5 2009 AND 2008 DoDSER SUBSTANCE(S) USED DURING EVENT FOR OEF/OIF AND NON-OEF/OIF EVENTS OEF/OIF Other OEF/OIF Other ALCOHOL USED Yes 0 0% 66 26% 0 0% 55 27% No 26 67% 89 34% 25 64% 70 34% Don t Know 13 33% 103 40% 14 36% 79 39% ANY DRUGS USED Yes 1 3% 18 7% 2 5% 15 7% No 25 64% 115 45% 21 54% 101 50% Don t Know 13 33% 125 48% 16 41% 88 43% Illegal drugs Overdose 0 0% 0 0% 0 0% 1 <1% Used, no overdose 0 0% 2 1% 0 0% 0 0% Were not used 26 67% 131 51% 23 59% 108 53% Don t Know 13 33% 125 48% 16 41% 95 47% Prescription drugs Overdose 0 0% 8 3% 2 5% 9 4% Used, no overdose 1 3% 2 1% 0 0% 4 2% Were not used 25 64% 123 48% 21 54% 102 50% Don t Know 13 33% 125 48% 16 41% 89 44% OTC drugs Overdose 0 0% 2 1% 0 0% 5 2% Used, no overdose 0 0% 5 2% 1 3% 1 <1% Were not used 26 67% 126 49% 22 56% 104 51% Don t Know 13 33% 125 48% 16 41% 94 46% Page 47
Chapter 3 DoD-Wide Results for Completed Suicides in OEF/OIF and Non-OEF/OIF Locations Table 3.5 2009 AND 2008 DoDSER SUBSTANCE(S) USED DURING EVENT FOR OEF/OIF AND NON-OEF/OIF EVENTS (cont.) OEF/OIF Other OEF/OIF Other BOTH ALCOHOL AND DRUGS USED Yes 0 0% 9 3% 0 0% 6 3% No 26 67% 121 47% 23 59% 108 53% Don t Know 13 33% 128 50% 16 41% 90 44% Communication of Intent DoDSER respondents indicate the types of individuals with whom decedents communicate their potential for self-harm. The majority of decedents for both OEF/OIF and non-oef/oif events had no known history of communicating their potential for self-harm before taking their lives (Table 3.6). For OEF/OIF events, 13% (n=5) were known to communicate their potential for self-harm before dying by suicide, and at least two Service Members who died by suicide (5%) reported this potential to multiple persons in a variety of roles (Table 3.7). Of the five OEF/OIF event decedents known to have communicated their potential for self-harm before dying by suicide, three (8%) communicated the message verbally. Table 3.6 2009 AND 2008 DoDSER RECIPIENTS OF COMMUNICATED INTENT FOR OEF/OIF AND NON-OEF/OIF EVENTS OEF/OIF Other OEF/OIF Other COMMUNICATION Friend 5 13% 23 9% 2 5% 18 9% Behavioral Health Staff 1 3% 15 6% 1 3% 10 5% Supervisor 2 5% 9 3% 1 3% 6 3% Spouse 0 0% 38 15% 1 3% 28 14% Chaplain 0 0% 4 2% 1 3% 3 1% Other 1 3% 29 11% 1 3% 28 14% Made Multiple Communication 2 5% 28 11% 0 0% 20 10% Page 48
Chapter 3 DoD-Wide Results for Completed Suicides in OEF/OIF and Non-OEF/OIF Locations Table 3.7 2009 AND 2008 DoDSER NUMBER OF TYPES OF RECIPIENTS OF COMMUNICATED INTENT FOR OEF/OIF AND NON-OEF/OIF EVENTS OEF/OIF Other OEF/OIF Other NUMBER OF TYPES OF RECIPIENTS OF COMMUNICATED INTENT 0 34 87% 180 70% 32 82% 136 67% 1 3 8% 50 19% 7 18% 48 24% 2 1 3% 20 8% 0 0% 15 7% 3 0 0% 5 2% 0 0% 5 2% 4 1 3% 2 1% 0 0% 0 0% 5 0 0% 1 <1% 0 0% 0 0% For OEF/OIF suicides, Service Members most commonly shared their potential for self-harm with friends and others. For non-oef/oif events, Service Members most commonly disclosed their potential for self-harm to spouses, followed by friends and others 4 (Table 3.8). Table 3.8 2009 AND 2008 DoDSER MODE OF COMMUNICATED INTENT FOR OEF/OIF AND NON-OEF/OIF EVENTS OEF/OIF Other OEF/OIF Other MODE OF COMMUNICATED INTENT Verbal Only 3 8% 44 17% 6 15% 38 19% Written Only 1 3% 6 2% 1 3% 2 1% Other 0 0% 18 7% 0 0% 9 4% Multiple Modes 1 3% 11 4% 0 0% 11 5% Note: Multiple Modes includes a combination of verbal, written, or other mode of communicating intent to suicide. 4 The category other includes a variety of co-workers and non-spousal family members. Page 49
Chapter 3 DoD-Wide Results for Completed Suicides in OEF/OIF and Non-OEF/OIF Locations Additional Event Information The information in this section includes data on whether alcohol or other drugs were used during the suicide (not necessarily as a method for self-harm), whether there is evidence the Service Member intended to die, and whether the decedent communicated potential for self-harm. Additional items in this section pertain to evidence of death-risk gambling such as Russian roulette or walking railroad tracks, planned or premeditated acts, and whether suicides were completed in areas or under circumstances in which the behavior was likely to be observed. As can be seen in Table 3.9, there was evidence that decedents intended to die for 90% (n=35) of OEF/OIF suicides. Fifteen OEF/OIF suicides appeared planned or premeditated and most took place where it was unlikely that others could observe or intervene (77%, n=30). A suicide note was reported to have been found for 28% (n=11) of OEF/OIF suicides. Table 3.9 2009 AND 2008 DoDSER OTHER EVENT INFORMATION FOR OEF/OIF AND NON-OEF/OIF EVENTS OEF/OIF Other OEF/OIF Other INTENDED TO DIE Yes 35 90% 191 74% 29 74% 142 70% No 2 5% 14 5% 1 3% 14 7% Don't Know 2 5% 53 21% 9 23% 48 24% DEATH RISK GAMBLING Yes 0 0% 4 2% 1 3% 4 2% No 36 92% 216 84% 31 79% 139 68% Don't Know 3 8% 38 15% 7 18% 61 30% PLANNED/PREMEDITATED Yes 15 38% 102 40% 15 38% 77 38% No 9 23% 77 30% 10 26% 55 27% Don't Know 15 38% 79 31% 14 36% 72 35% OBSERVABLE Yes 5 13% 56 22% 5 13% 42 21% No 30 77% 174 67% 30 77% 113 55% Don't Know 4 10% 28 11% 4 10% 49 24% SUICIDE NOTE LEFT Yes 11 28% 63 24% 11 28% 44 22% No 20 51% 140 54% 16 41% 96 47% Don't Know 8 21% 55 21% 12 31% 64 31% Page 50
Chapter 3 DoD-Wide Results for Completed Suicides in OEF/OIF and Non-OEF/OIF Locations Contextual Factors This section describes DoDSER data that pertains to contextual factors such as the home and duty environments. Home Environment As can be seen in Table 3.10, Service Members most often lived with others for both OEF/OIF suicides (82%, n=32) and non-oef/oif suicides (53%, n=137). 31% (n=12) of OEF/OIF decedents were reported to have minor children. As expected, only two OEF/OIF decedents did not have access to firearms. Table 3.10 2009 AND 2008 DoDSER HOME ENVIRONMENT FOR OEF/OIF AND NON-OEF/OIF EVENTS OEF/OIF Other OEF/OIF Other RESIDED ALONE Yes 5 13% 97 38% 5 13% 54 26% No 32 82% 136 53% 31 79% 116 57% Don't Know 2 5% 25 10% 3 8% 34 17% HAD MINOR CHILDREN Yes 12 31% 99 38% 13 33% 66 32% No 23 59% 135 52% 20 51% 96 47% Don't Know 4 10% 24 9% 6 15% 42 21% FIREARM IN IMMEDIATE/LIVING ENVIRONMENT Yes 32 82% 114 44% 34 87% 99 49% No 2 5% 77 30% 0 0% 36 18% Don't Know 5 13% 67 26% 5 13% 69 34% Page 51
Chapter 3 DoD-Wide Results for Completed Suicides in OEF/OIF and Non-OEF/OIF Locations Suicide Completions by Month Table 3.11 shows suicide counts by month for the combined Services for both OEF/OIF events and non-oef/oif events. Table 3.11 2009 AND 2008 DoDSER SUICIDE EVENTS BY MONTH FOR OEF/OIF AND NON-OEF/OIF EVENTS OEF/OIF Other OEF/OIF Other MONTH January 4 10% 23 9% 2 5% 20 10% February 2 5% 31 12% 3 8% 12 6% March 4 10% 15 6% 1 3% 17 8% April 7 18% 17 7% 4 10% 17 8% May 5 13% 24 9% 3 8% 17 8% June 2 5% 22 9% 5 13% 14 7% July 1 3% 28 11% 4 10% 19 9% August 2 5% 19 7% 5 13% 15 7% September 1 3% 15 6% 4 10% 16 8% October 3 8% 29 11% 2 5% 18 9% November 5 13% 16 6% 3 8% 23 11% December 3 8% 19 7% 3 8% 16 8% Clinical/Symptom Factors The DoDSER also captures detailed information on clinical, behavioral, and symptom factors that may be associated with subsequent suicidal behavior. These factors include data on prior self-harm, previous diagnoses of behavioral health disorders and behavioral health issues, and relevant treatment histories, including prescribed medication. Page 52
Chapter 3 DoD-Wide Results for Completed Suicides in OEF/OIF and Non-OEF/OIF Locations Prior Self-Injury As can be seen in Table 3.12, prior self-injury was not reported for the majority of suicide decedents for both OEF/OIF events (64%, n=25) and non-oef/oif events (58%, n=148). Five percent (n=2) of OEF/OIF decedents with a history of self-injury had one prior event compared to 11% (n=28) for non-oef/oif decedents. Similar to non-oef/oif decedents, 8% (n=3) of OEF/OIF decedents had a history of more than one event. Data on whether the latest self-injury was similar to prior self-injuries and the time between previous and latest events are also shown in Table 3.12. Table 3.12 2009 AND 2008 DoDSER PRIOR SELF-INJURY FOR OEF/OIF AND NON-OEF/OIF EVENTS OEF/OIF Other OEF/OIF Other HX PRIOR SELF-INJURY Yes 5 13% 46 18% 4 10% 29 14% Within 30 days 1 3% 11 4% 0 0% 6 3% Within 90 days (inclusive)* 1 3% 22 9% 1 3% 11 5% No 25 64% 148 57% 17 44% 94 46% Don't Know 9 23% 64 25% 18 46% 81 40% Number prior self-injuries One prior event 2 5% 28 11% ---- ---- ---- ---- More than one prior event 3 8% 18 7% ---- ---- ---- ---- N/A 34 87% 212 82% ---- ---- ---- ---- Event similar to prior self-injury Yes 0 0% 9 3% 0 0% 6 3% No 3 8% 27 10% 4 10% 17 8% Don't Know 2 5% 10 4% 0 0% 6 3% N/A 34 87% 212 82% 35 90% 175 86% Note: Number of prior self-injuries not available for 2008. *Data presented for Within 90 days includes all cases that reported the event Within 30 days. Page 53
Chapter 3 DoD-Wide Results for Completed Suicides in OEF/OIF and Non-OEF/OIF Locations Behavioral Health Disorders Twenty-eight percent (n=11) of OEF/OIF decedents had a history of at least one behavioral health disorder compared to 45% (n =115) for non- OEF/OIF decedents (Table 3.13). As shown in Table 3.14, 10% (n=4) of decedents had been diagnosed with a mood disorder, including major depression (n=1) and unspecified mood disorders (n=2). Thirteen percent (n=5) had been diagnosed with an anxiety disorder, including posttraumatic stress disorder (PTSD; 3%; Table 3.15). As indicated in Table 3.16, one decedent had been diagnosed with a psychotic disorder, one had been diagnosed with a personality disorder, and 15% (n=6) had a history of substance abuse. Table 3.13 2009 AND 2008 DoDSER COMORBIDITY RATES FOR OEF/OIF AND NON-OEF/OIF EVENTS OEF/OIF Other OEF/OIF Other NUMBER OF BEHAVIORAL HEALTH DIAGNOSES No DX 28 72% 143 55% 27 69% 137 67% 1 DX 7 18% 59 23% 6 15% 49 24% 2 DX 1 3% 36 14% 2 5% 9 4% 3 DX 2 5% 11 4% 4 10% 6 3% 4 or more DX 1 3% 9 3% 0 0% 3 1% Table 3.14 2009 AND 2008 DoDSER MOOD DISORDERS FOR OEF/OIF AND NON-OEF/OIF EVENTS OEF/OIF Other OEF/OIF Other DX W/ MOOD DISORDER Yes 4 10% 71 28% 9 23% 37 18% No 27 69% 151 59% 20 51% 122 60% Don't Know 8 21% 36 14% 10 26% 45 22% Page 54
Chapter 3 DoD-Wide Results for Completed Suicides in OEF/OIF and Non-OEF/OIF Locations Table 3.14 2009 AND 2008 DoDSER MOOD DISORDERS FOR OEF/OIF AND NON-OEF/OIF EVENTS (cont.) OEF/OIF Other OEF/OIF Other Bipolar disorder Yes 0 0% 2 1% 0 0% 2 1% No 28 72% 211 82% 28 72% 147 72% Don't Know 11 28% 45 17% 11 28% 55 27% Major depression Yes 1 3% 33 13% 4 10% 9 4% No 28 72% 183 71% 24 62% 143 70% Don't Know 10 26% 42 16% 11 28% 52 25% Dysthymic disorder Yes 0 0% 5 2% 0 0% 2 1% No 28 72% 206 80% 29 74% 147 72% Don't Know 11 28% 47 18% 10 26% 55 27% Other mood disorder Yes 0 0% 15 6% 5 13% 16 8% No 28 72% 198 77% 24 62% 132 65% Don't Know 11 28% 45 17% 10 26% 56 27% Unspecified mood disorder Yes 2 5% 7 3% 0 0% 6 3% No 29 74% 215 83% 29 74% 153 75% Don't Know 8 21% 36 14% 10 26% 45 22% Multiple mood DX Yes 1 3% 9 3% 0 0% 2 1% No 30 77% 213 83% 29 74% 157 77% Don't Know 8 21% 36 14% 10 26% 45 22% Page 55
Chapter 3 DoD-Wide Results for Completed Suicides in OEF/OIF and Non-OEF/OIF Locations Table 3.15 2009 AND 2008 DoDSER ANXIETY DISORDERS FOR OEF/OIF AND NON-OEF/OIF EVENTS OEF/OIF Other OEF/OIF Other DX W/ ANXIETY DISORDER Yes 5 13% 48 19% 5 13% 20 10% No 24 62% 172 67% 24 62% 141 69% Don't Know 10 26% 38 15% 10 26% 43 21% PTSD Yes 1 3% 18 7% 2 5% 4 2% No 27 69% 198 77% 25 64% 151 74% Don't Know 11 28% 42 16% 12 31% 49 24% Panic disorder Yes 0 0% 0 0% 1 3% 0 0% No 28 72% 215 83% 26 67% 153 75% Don't Know 11 28% 43 17% 12 31% 51 25% Generalized anxiety disorder Yes 1 3% 2 1% 0 0% 1 <1% No 28 72% 213 83% 26 67% 154 75% Don't Know 10 26% 43 17% 13 33% 49 24% Acute stress disorder Yes 0 0% 0 0% 0 0% 1 <1% No 28 72% 215 83% 26 67% 155 76% Don't Know 11 28% 43 17% 13 33% 48 24% Other anxiety disorder Yes 1 3% 14 5% 1 3% 5 2% No 27 69% 202 78% 26 67% 148 73% Don't Know 11 28% 42 16% 12 31% 51 25% Unspecified anxiety DX Yes 0 0% 5 2% 0 0% 4 2% No 29 74% 215 83% 29 74% 157 77% Don't Know 10 26% 38 15% 10 26% 43 21% Page 56
Chapter 3 DoD-Wide Results for Completed Suicides in OEF/OIF and Non-OEF/OIF Locations Table 3.15 2009 AND 2008 DoDSER ANXIETY DISORDERS FOR OEF/OIF AND NON-OEF/OIF EVENTS (cont.) OEF/OIF Other OEF/OIF Other Multiple anxiety DX Yes 2 5% 9 3% 1 3% 5 2% No 27 69% 211 82% 28 72% 156 76% Don't Know 10 26% 38 15% 10 26% 43 21% Table 3.16 2009 AND 2008 DoDSER OTHER BEHAVIORAL HEALTH DISORDERS FOR OEF/OIF AND NON-OEF/OIF EVENTS OEF/OIF Other OEF/OIF Other DX W/PERSONALITY DISORDER Yes 1 3% 14 5% 1 3% 11 5% No 28 72% 202 78% 25 64% 150 74% Don't Know 10 26% 42 16% 13 33% 43 21% DX W/PSYCHOTIC DISORDER Yes 1 3% 2 1% 0 0% 2 1% No 29 74% 216 84% 28 72% 159 78% Don't Know 9 23% 40 16% 11 28% 43 21% HX SUBSTANCE ABUSE Yes 6 15% 58 22% 7 18% 42 21% No 24 62% 146 57% 20 51% 114 56% Don't Know 9 23% 54 21% 12 31% 48 24% Page 57
Chapter 3 DoD-Wide Results for Completed Suicides in OEF/OIF and Non-OEF/OIF Locations Treatment Table 3.17 displays the history of decedents visits to treatment programs and clinics prior to suicide. The table displays the number of Service Members who had been seen in a program or clinic prior to death, including the 30 and 90 days prior to death. DoDSER respondents were instructed to select all categories that apply, thus they are not mutually exclusive. A total of 16 (41%) Service members who completed suicide while in OEF/OIF were seen at military treatment facilities (MTFs) within the year preceding suicide. Of these, 26% (n=10) of decedents had been seen in MTFs within 90 days of the suicide and 18% (n=7) had been seen within 30 days. Fifteen percent (n=6) had been seen in outpatient behavioral health facilities within 30 days of the suicide, and 21% (n=8) within 90 days. Table 3.17 also summarizes information about visits to the other programs and broadly-defined behavioral health resources (i.e., Chaplain, Family Advocacy Program, Alcohol and Substance Abuse Program, and Inpatient Behavioral Health facilities) within 30 and 90 days. Table 3.18 summarizes decedents prescription drug use. Table 3.17 2009 AND 2008 DoDSER TREATMENT HISTORY FOR OEF/OIF AND NON-OEF/OIF EVENTS OEF/OIF Other OEF/OIF Other SEEN AT MILITARY TREATMENT Yes 16 41% 159 62% 19 49% 107 52% FACILITY Within 30 days 7 18% 100 39% 12 31% 59 29% Within 90 days (inclusive)* 10 26% 133 52% 16 41% 80 39% No 16 41% 64 25% 9 23% 56 27% Don't Know 7 18% 35 14% 11 28% 41 20% SUBSTANCE ABUSE SERVICES Yes 3 8% 46 18% 2 5% 25 12% Within 30 days 0 0% 24 9% 0 0% 10 5% Within 90 days (inclusive)* 0 0% 26 10% 0 0% 15 7% No 27 69% 173 67% 25 64% 138 68% Don't Know 9 23% 39 15% 12 31% 41 20% FAMILY ADVOCACY PROGRAMS Yes 1 3% 19 7% 0 0% 15 7% Within 30 days 0 0% 4 2% 0 0% 8 4% Page 58
Chapter 3 DoD-Wide Results for Completed Suicides in OEF/OIF and Non-OEF/OIF Locations Table 3.17 2009 AND 2008 DoDSER TREATMENT HISTORY FOR OEF/OIF AND NON-OEF/OIF EVENTS (cont.) OEF/OIF Other OEF/OIF Other Within 90 days (inclusive)* 0 0% 9 3% 0 0% 9 4% No 26 67% 185 72% 27 69% 142 70% Don't Know 12 31% 54 21% 12 31% 47 23% CHAPLAIN SERVICES Yes 8 21% 30 12% 9 23% 25 12% Within 30 days 7 18% 17 7% 7 18% 11 5% Within 90 days (inclusive)* 8 21% 24 9% 8 21% 17 8% No 18 46% 107 41% 13 33% 90 44% Don't Know 13 33% 121 47% 17 44% 89 44% OUTPATIENT BEHAVIORAL HEALTH Yes 14 36% 107 41% 16 41% 64 31% Within 30 days 6 15% 57 22% 9 23% 32 16% Within 90 days (inclusive)* 8 21% 65 25% 11 28% 43 21% No 18 46% 120 47% 18 46% 106 52% Don't Know 7 18% 31 12% 5 13% 34 17% INPATIENT BEHAVIORAL HEALTH Yes 2 5% 43 17% 3 8% 22 11% Within 30 days 0 0% 7 3% 0 0% 10 5% Within 90 days (inclusive)* 0 0% 19 7% 0 0% 13 6% No 27 69% 180 70% 29 74% 136 67% Don't Know 10 26% 35 14% 7 18% 46 23% HX PHYSICAL HEALTH PROBLEM Yes 2 5% 62 24% 5 13% 44 22% Within 30 days 1 3% 36 14% 3 8% 24 12% Within 90 days (inclusive)* 1 3% 43 17% 5 13% 35 17% No 26 67% 140 54% 25 64% 111 54% Don't Know 11 28% 56 22% 9 23% 49 24% Page 59
Chapter 3 DoD-Wide Results for Completed Suicides in OEF/OIF and Non-OEF/OIF Locations Table 3.18 2009 AND 2008 DoDSER PSYCHOTROPIC MEDICATION USE FOR OEF/OIF AND NON-OEF/OIF EVENTS OEF/OIF Other OEF/OIF Other TAKEN PSYCHOTROPIC MEDS Yes 5 13% 66 26% 11 28% 40 20% No 24 62% 138 53% 19 49% 108 53% Don't Know 10 26% 54 21% 9 23% 56 27% Antidepressants Yes 3 8% 59 23% 9 23% 34 17% No 26 67% 144 56% 20 51% 111 54% Don't Know 10 26% 55 21% 10 26% 59 29% Antianxiety Yes 2 5% 25 10% 4 10% 12 6% No 27 69% 175 68% 24 62% 133 65% Don't Know 10 26% 58 22% 11 28% 59 29% Antimanics Yes 0 0% 2 1% 0 0% 2 1% No 29 74% 198 77% 27 69% 141 69% Don't Know 10 26% 58 22% 12 31% 61 30% Anticonvulsants Yes 0 0% 7 3% 0 0% 5 2% No 29 74% 194 75% 27 69% 138 68% Don't Know 10 26% 57 22% 12 31% 61 30% Antipsychotics Yes 1 3% 14 5% 0 0% 6 3% No 28 72% 187 72% 27 69% 138 68% Don't Know 10 26% 57 22% 12 31% 60 29% Historical/Developmental Factors DoDSER data are collected on historical or developmental factors that precede a suicide event. These data include information about family histories and interpersonal relationships, legal, financial and administrative difficulties, and reports of prior abuse. Page 60
Chapter 3 DoD-Wide Results for Completed Suicides in OEF/OIF and Non-OEF/OIF Locations Family and Relationship History Table 3.19 reports relationship history factors. Failed marital or intimate relationships were reported for 46% (n=18) of OEF/OIF decedents. In addition, other failed relationships (non-intimate) were reported for 18% (n=7) of suicide decedents. Fifty-four percent (n=21) of decedents reportedly had a history of failure for either intimate or non-intimate relationship prior to death. Most of these failed relationships occurred close in time to the suicidal behaviors for both OEF/OIF events and non-oef/oif events. Twenty-six percent (n=10) of OEF/OEF events had failed intimate relationships within 30 days of the suicide. Other failed relationships occurred within 30 days of the suicides for 15% (n=6) of OEF/OIF suicides. Table 3.19 2009 AND 2008 DoDSER RELATIONSHIP HISTORY FOR OEF/OIF AND NON-OEF/OIF EVENTS OEF/OIF Other OEF/OIF Other HX FAILED INTIMATE RELATIONSHIP Yes 18 46% 132 51% 18 46% 109 53% Within 30 days 10 26% 71 28% 13 33% 67 33% Within 90 days (inclusive)* 13 33% 89 34% 15 38% 90 44% No 10 26% 66 26% 9 23% 49 24% Don't Know 11 28% 60 23% 12 31% 46 23% HX FAILED OTHER RELATIONSHIP Yes 7 18% 32 12% 4 10% 31 15% Within 30 days 6 15% 18 7% 3 8% 16 8% Within 90 days (inclusive)* 7 18% 20 8% 3 8% 23 11% No 16 41% 126 49% 13 33% 93 46% Don't Know 16 41% 100 39% 22 56% 80 39% HX ANY FAILED RELATIONSHIP Yes 21 54% 137 53% 19 49% 118 58% Within 30 days 14 36% 74 29% 15 38% 73 36% Within 90 days (inclusive)* 17 44% 92 36% 16 41% 96 47% No 8 21% 64 25% 8 21% 42 21% Don't Know 10 26% 57 22% 12 31% 44 22% Page 61
Chapter 3 DoD-Wide Results for Completed Suicides in OEF/OIF and Non-OEF/OIF Locations There were also reported histories of recent spousal or family death (other than by suicide) for 5% (n=2) of OEF/OIF suicides, as shown in Table 3.20. Chronic spousal or family severe illness was reported for 8% (n=3) of OEF/OIF suicides and family histories of behavioral health illness or suicide was reported for 18% (n=7) of decedents. These rates are similar to those of non-oef/oif suicides and are likely underestimates for both OEF/OIF and non-oef/oif events because don t know responses were common for all risk factors. Table 3.20 2009 AND 2008 DoDSER FAMILY HISTORY FOR OEF/OIF AND NON-OEF/OIF EVENTS OEF/OIF Other OEF/OIF Other HX SPOUSE SUICIDE Yes 0 0% 1 <1% 0 0% 1 <1% No 31 79% 218 84% 31 79% 146 72% Don't Know 8 21% 39 15% 8 21% 57 28% HX FAMILY MEMBER SUICIDE Yes 1 3% 11 4% 1 3% 10 5% No 24 62% 166 64% 24 62% 95 47% Don't Know 14 36% 81 31% 14 36% 99 49% HX FRIEND SUICIDE Yes 1 3% 4 2% 0 0% 3 1% No 24 62% 149 58% 24 62% 98 48% Don't Know 14 36% 105 41% 15 38% 103 50% HX DEATH OF FAMILY MEMBER Yes 2 5% 16 6% 2 5% 15 7% No 24 62% 151 59% 23 59% 94 46% Don't Know 13 33% 91 35% 14 36% 95 47% HX DEATH OF FRIEND Yes 0 0% 9 3% 2 5% 10 5% No 25 64% 135 52% 20 51% 81 40% Don't Know 14 36% 114 44% 17 44% 113 55% HX FAMILY ILLNESS Yes 3 8% 16 6% 2 5% 10 5% No 22 56% 158 61% 19 49% 91 45% Don't Know 14 36% 84 33% 18 46% 103 50% Page 62
Chapter 3 DoD-Wide Results for Completed Suicides in OEF/OIF and Non-OEF/OIF Locations Table 3.20 2009 AND 2008 DoDSER FAMILY HISTORY FOR OEF/OIF AND NON-OEF/OIF EVENTS (cont.) HX FAMILY BEHAVIORAL HEALTH PROBLEMS OEF/OIF Other OEF/OIF Other Yes 7 18% 37 14% 5 13% 16 8% No 11 28% 79 31% 7 18% 39 19% Don't Know 21 54% 142 55% 27 69% 149 73% Administrative and Legal History Article 15 proceedings were reported for 10% (n=4) of OEF/OIF events compared to 16% (n=42) for non-oef/oif suicides. Civil legal problems were reported among 5% (n=2) of OEF/OIF events compared to 13% (n=34) of non-oef/oif suicides. Other administrative and legal risk factors were less commonly reported, as shown in Table 3.21. Table 3.21 2009 AND 2008 DoDSER ADMIN/LEGAL HISTORY FOR OEF/OIF AND NON-OEF/OIF EVENTS OEF/OIF Other OEF/OIF Other HX COURTS MARTIAL Yes 0 0% 19 7% 1 3% 2 1% No 34 87% 201 78% 30 77% 169 83% Don't Know 5 13% 38 15% 8 21% 33 16% HX ARTICLE 15 Yes 4 10% 42 16% 7 18% 19 9% No 29 74% 148 57% 19 49% 73 36% Don't Know 6 15% 68 26% 13 33% 112 55% HX ADMIN SEPARATION Yes 1 3% 24 9% 2 5% 12 6% No 33 85% 197 76% 30 77% 150 74% Don't Know 5 13% 37 14% 7 18% 42 21% Page 63
Chapter 3 DoD-Wide Results for Completed Suicides in OEF/OIF and Non-OEF/OIF Locations Table 3.21 2009 AND 2008 DoDSER ADMIN/LEGAL HISTORY FOR OEF/OIF AND NON-OEF/OIF EVENTS (cont.) OEF/OIF Other OEF/OIF Other HX AWOL Yes 0 0% 30 12% 1 3% 13 6% No 34 87% 195 76% 32 82% 150 74% Don't Know 5 13% 33 13% 6 15% 41 20% HX MEDICAL BOARD Yes 0 0% 24 9% 1 3% 8 4% No 34 87% 201 78% 31 79% 154 75% Don't Know 5 13% 33 13% 7 18% 42 21% HX CIVIL LEGAL PROBLEMS Yes 2 5% 34 13% 4 10% 28 14% No 30 77% 164 64% 25 64% 126 62% Don't Know 7 18% 60 23% 10 26% 50 25% HX NON-SELECTION Yes 2 5% 21 8% 1 3% 9 4% No 31 79% 188 73% 25 64% 130 64% Don't Know 6 15% 49 19% 13 33% 65 32% Page 64
Chapter 3 DoD-Wide Results for Completed Suicides in OEF/OIF and Non-OEF/OIF Locations Abuse History As shown in Table 3.22, 8% (n=3) of OEF/OIF events had a reported history of physical abuse, 5% (n=2) had a history of sexual abuse, and 10% (n=4) had a history of emotional abuse. Sexual harassment was reported for one OEF/OIF event. Abuse in which the decedent was the perpetrator was not frequently indicated, although DoDSERs for 8% (n=3) of OEF/OIF events reported that they had been alleged or confirmed perpetrators of physical abuse and that 5% (n=2) had been alleged or confirmed perpetrators of sexual abuse. Table 3.22 2009 AND 2008 DoDSER ABUSE HISTORY FOR OEF/OIF AND NON-OEF/OIF EVENTS OEF/OIF Other OEF/OIF Other HX VICTIM PHYSICAL ABUSE Yes 3 8% 17 7% 2 5% 8 4% No 28 72% 148 57% 16 41% 99 49% Don't Know 8 21% 93 36% 21 54% 97 48% HX VICTIM SEXUAL ABUSE Yes 2 5% 11 4% 2 5% 4 2% No 29 74% 154 60% 17 44% 105 51% Don't Know 8 21% 93 36% 20 51% 95 47% HX VICTIM EMOTIONAL ABUSE Yes 4 10% 17 7% 2 5% 9 4% No 26 67% 145 56% 16 41% 97 48% Don't Know 9 23% 96 37% 21 54% 98 48% HX VICTIM SEXUAL HARASSMENT Yes 1 3% 0 0% 0 0% 0 0% No 29 74% 159 62% 19 49% 107 52% Don't Know 9 23% 99 38% 20 51% 97 48% HX PERPETRATOR PHYSICAL ABUSE Yes 3 8% 23 9% 0 0% 13 6% No 25 64% 148 57% 22 56% 94 46% Don't Know 11 28% 87 34% 17 44% 97 48% Page 65
Chapter 3 DoD-Wide Results for Completed Suicides in OEF/OIF and Non-OEF/OIF Locations Table 3.22 2009 AND 2008 DoDSER ABUSE HISTORY FOR OEF/OIF AND NON-OEF/OIF EVENTS (cont.) OEF/OIF Other OEF/OIF Other HX PERPETRATOR SEXUAL ABUSE Yes 2 5% 8 3% 1 3% 8 4% No 26 67% 157 61% 22 56% 102 50% Don't Know 11 28% 93 36% 16 41% 94 46% HX PERPETRATOR EMOTIONAL ABUSE Yes 2 5% 7 3% 1 3% 7 3% No 26 67% 153 59% 22 56% 100 49% Don't Know 11 28% 98 38% 16 41% 97 48% HX PERPETRATOR SEXUAL HARASSMENT Yes 2 5% 3 1% 1 3% 2 1% No 25 64% 160 62% 22 56% 107 52% Don't Know 12 31% 95 37% 16 41% 95 47% Page 66
Chapter 3 DoD-Wide Results for Completed Suicides in OEF/OIF and Non-OEF/OIF Locations Financial and Workplace Difficulties Excessive debt or bankruptcy was reported for 13% (n=5) of OEF/OIF decedents compared to 10% (n=27) for non-oef/oif decedents. A history of job problems was reported for 36% (n=14) of OEF/OIF decedents compared to 26% (n=67) for non-oef/oif decedents. There was a greater percentage of reported history of supervisor or co-worker issues for OEF/OIF events (36%, n=14) compared to non-oef/oif suicides (11%, n=28). Additional information related to job or employment difficulties is presented in Table 3.23. Table 3.23 2009 AND 2008 DoDSER FINANCIAL AND WORKPLACE DIFFICULTIES FOR OEF/OIF AND NON-OEF/OIF EVENTS OEF/OIF Other OEF/OIF Other EXCESSIVE DEBT/BANKRUPTCY Yes 5 13% 27 10% 2 5% 23 11% No 22 56% 139 54% 21 54% 104 51% Don't Know 12 31% 92 36% 16 41% 77 38% HX JOB LOSS/INSTABILITY Yes 14 36% 67 26% 9 23% 35 17% No 17 44% 134 52% 21 54% 128 63% Don't Know 8 21% 57 22% 9 23% 41 20% HX SUPERVISOR/COWORKER ISSUES Yes 14 36% 28 11% 10 26% 16 8% No 15 38% 164 64% 19 49% 117 57% Don't Know 10 26% 66 26% 10 26% 71 35% HX POOR WORK EVALUATION Yes 11 28% 39 15% 7 18% 20 10% No 21 54% 164 64% 20 51% 125 61% Don't Know 7 18% 55 21% 12 31% 59 29% HX UNIT/WORKPLACE HAZING Yes 2 5% 3 1% 1 3% 1 <1% No 23 59% 185 72% 24 62% 134 66% Don't Know 14 36% 70 27% 14 36% 69 34% Page 67
Deployment Factors DoDSER 2009 Annual Report Chapter 3 DoD-Wide Results for Completed Suicides in OEF/OIF and Non-OEF/OIF Locations The 2009 DoDSER captured detailed information pertaining to the Service Members most recent three deployments. Data include deployment location information as well as a history of direct combat operations. Deployment History and Days Deployed Figure 3.2 displays the length of time that Service Members were deployed prior to suicide in OEF/OIF. 100 90 80 70 Percentage 60 50 40 30 20 10 0 15% 23% 10% 15% 10% 3% 5% 8% <1% <1% <1% 3% 8% Month (30 Days) Figure 3.2 2009 OEF/OIF MONTHS DEPLOYED Page 68
Chapter 3 DoD-Wide Results for Completed Suicides in OEF/OIF and Non-OEF/OIF Locations Table 3.24 summarizes deployment history for Service Members who completed suicide in OEF/OIF and in non-oef/oif locations. The deployment during which the Service Member died is included in the counts. The Other group includes decedents who never deployed, thus the percentages will not sum to 100%. Forty-one percent (n=16) of OEF/OIF decedents had deployed more than once. Forty-nine percent (n=19) died by suicide within the first three months of their OEF/OIF deployment, and an additional 28% (n=11) within the next three months. Table 3.24 2009 AND 2008 DoDSER NUMBER OF DEPLOYMENTS FOR OEF/OIF AND NON-OEF/OIF EVENTS OEF/OIF Other OEF/OIF Other NUMBER OF DEPLOYMENTS 1 23 59% 77 30% 25 64% 66 32% 2 10 26% 42 16% 9 23% 20 10% 3 or more 6 15% 33 13% 4 10% 8 4% Page 69
Chapter 3 DoD-Wide Results for Completed Suicides in OEF/OIF and Non-OEF/OIF Locations Combat History Ten percent (n=4) of OEF/OIF decedents had a reported history of direct combat operations compared to 18% (n=47) of non-oef/oif decedents (Table 3.25). One OEF/OIF decedent had witnessed casualties compared to 60% of those with combat experience (n=28) for non-oef/oif decedents. Table 3.25 2009 AND 2008 DoDSER COMBAT HISTORY FOR OEF/OIF AND NON-OEF/OIF EVENTS OEF/OIF Other OEF/OIF Other COMBAT HISTORY HX DIRECT COMBAT 4 10% 47 18% 7 18% 32 16% Combat Resulted in Injuries/Casualties 1 25% 33 28% 4 57% 18 56% Injured in Combat 0 0% 10 21% 1 14% 7 22% Witnessed in Combat 1 25% 28 60% 3 43% 17 53% Saw Dead Bodies in Combat 1 25% 27 57% 3 43% 14 44% Killed Others in Combat 0 0% 12 36% 1 14% 7 22% NO DIRECT COMBAT HX 35 90% 211 82% 32 82% 172 84% Note: Indented items were only asked in cases for which the respondent indicated that the decedent had participated in direct combat. Percentages for these items reflect proportion of those with combat experience. Page 70
Chapter 3 DoD-Wide Results for Completed Suicides in OEF/OIF and Non-OEF/OIF Locations Summary For calendar year 2009, characteristics of decedents of suicide that occurred during OEF/OIF deployments were presented in this report. Of the 309 suicides that occurred in 2009, 43 occurred during OEF/OIF; DoDSERs were submitted for 39 of the OEF/OIF suicides. The majority of OEF/OIF suicides occurred at decedents military residences (62%, n=24). Thirteen percent (n=5) of OEF/OIF suicides occurred at job sites and 26% (n=10) occurred at other settings. Consistent with 2008, military firearms were the most reported method for OEF/OIF suicides (97%, n=38). The majority of suicide decedents did not have a reported history of prior self-injury. Five percent (n=2) had history of one prior event and 8% (n=3) had a history of more than one event. Twenty-eight percent (n=11) of OEF/OIF decedents had a history of at least one behavioral health disorder. Ten percent (n=4) of decedents had been diagnosed with mood disorders. Thirteen percent (n=5) had been diagnosed with anxiety disorders, including one decedent diagnosed with PTSD. One decedent had a history of substance abuse. Twenty-six percent (n=10) of OEF/OIF decedents had been seen in MTFs within 90 days of the suicide and 18% (n=7) had been seen within 30 days. Fifteen percent of OEF/OIF decedents (n=6) had been seen in outpatient behavioral health facilities within 30 days of the suicide, and 21% (n=8) within 90 days. Twenty-six percent (n=10) of OEF/OIF decedents had a failed intimate relationship within 30 days of the suicide. Other failed relationships occurred within 30 days of the events in 15% (n=6) of suicides. The overall percent of failed relationships for OEF/OIF decedents (54%, n=21) was similar to that of non OEF/OIF decedents (53%, n=137). Thirty-one percent (n=12) of decedents were reported to have had minor children at the time of the suicide. Article 15 proceedings were reported for 10% of decedents (n=4) and civil legal problems were reported among 5% of individuals (n=2). Excessive debt or bankruptcy was reported for 13% (n=5) of OEF/OIF suicides. A history of job problems was reported for 36% (n=14) of OEF/OIF decedents and a history of supervisor or co-worker issues was reported for 36% (n=14) of decedents. Ten percent (n=4) of decedents were reported to have experienced direct combat operations. Similar to 2008, the percentages of decedents who had experienced combat were generally low. The percentage of OEF/OIF decedents who experienced direct combat operations (10%, n=4) was lower than non OEF/OIF decedents (18%, n=47). Page 71
Chapter 4 AIR FORCE RESULTS FOR COMPLETED SUICIDES Air Force DoDSER Submissions and POC Compliance 2009 Reported Suicide Events Forty-three Air Force suicides were confirmed by the Armed Forces Medical Examiner System (AFMES) for calendar year 2009 (Table 4.1). Forty-three Air Force Department of Defense Suicide Event Reports (DoDSERs) were submitted and analyzed, for a submission compliance rate of 100%. An additional three DoDSERs were submitted and analyzed, but not confirmed by AFMES at the time of analysis. Consequently, a total of 46 suicides for 2009 were included in this report. Table 4.1 2009 AIR FORCE AFMES CONFIRMED AND PENDING SUICIDES AND DoDSERs SUBMITTED 2009 Total DoDSERs 46 d Total AFMES Confirmed and Pending Suicides 46 d AFMES Confirmed Suicides 43 d DoDSER Submission Compliance 100% d Additional DoDSERs Pending AFMES Confirmation 3 d Data from 1/1/2009 through 12/31/2009 as of 4/1/2010 Dispositional/Personal Factors This section reports data that describe internal characteristics or individual behaviors of decedents that may have been associated with or contributed to the suicidal events. These factors include decedents demographic characteristics, event setting, suicide method, substance use during the event, possible motive and intent to die, and communication of intent with others. Demographics Table 4.2 contains demographic data provided from DMDC. All but two of the 46 Air Force 2009 suicides were completed by males. Decedents were primarily Caucasian, enlisted, and regular component, consistent with 2008. Table 4.2 2009 AND 2008 AFMES AIR FORCE DEMOGRAPHICS Page 72
Chapter 4 Air Force Results for Completed Suicides Table 4.2 2009 AND 2008 AFMES AIR FORCE DEMOGRAPHICS (cont.) Total 46 100% 45 100% GENDER Male 44 97% 43 96% Female 2 3% 2 4% RACE Asian/Pacific Islander 2 4% 1 2% African American 5 11% 4 9% Caucasian 35 76% 30 67% American Indian/Alaska Native 2 4% 4 9% Other/Don t Know/Missing 2 4% 6 13% AGE RANGE Under 25 17 37% 20 44% 25-29 11 24% 4 9% 30-39 10 22% 11 24% 40 + 8 17% 10 22% RANK E1-E4 21 46% 15 33% E5-E9 20 43% 23 51% Officer 5 11% 7 16% Warrant Officer 0 0% 0 0% Cadet/Midshipman 0 0% 0 0% COMPONENT Regular 41 89% 39 87% Reserve 3 7% 1 2% National Guard 2 4% 5 11% EDUCATION Did not graduate high school 0 0% 0 0% GED 0 0% 0 0% High school graduate 35 76% 27 60% Some college or technical school 1 2% 0 0% Degree/certificate of less than 4 years 4 9% 8 18% Four-year college degree 1 2% 5 11% Master s degree or greater 5 11% 5 11% Don t Know 0 0% 0 0% MARITAL STATUS Never Married 14 30% 12 27% Married 26 57% 26 58% Legally Separated 0 0% 0 0% Divorced 6 13% 7 16% Widowed 0 0% 0 0% Don t Know 0 0% 0 0% Note: Demographic data were obtained from the DMDC with assistance from the AFMES and reflect suicide events from 1/1/2008 through Page 73
Chapter 4 Air Force Results for Completed Suicides Table 4.2 2009 AND 2008 AFMES AIR FORCE DEMOGRAPHICS 12/31/2009 as of 4/1/2010. Event Setting The most common settings for Air Force suicides in 2009 were Airmen s personal residences or barracks (67%, n=31), an increase of 10% from the previous year (Table 4.3). Two additional 2009 suicides occurred at the residence of a family or friend, and three in automobiles, unlike 2008 when there were none in either setting. Ten other event locations were reported, primarily public outdoor settings. The AFMES reported 2 Air Force OIF suicides and 1 OEF suicide as of 1 April 2010. DoDSER data provides a description of the event country. Six Air Force suicides took place while Service Members were serving outside the United States (Table 4.4). Table 4.3 2009 AND 2008 AIR FORCE DoDSER EVENT SETTING EVENT SETTING Residence (own) or barracks 31 67% 20 57% Residence of friend or family 2 4% 0 0% Work/jobsite 0 0% 2 6% Automobile (away from residence) 3 7% 0 0% Inpatient medical facility 0 0% 0 0% Other 10 22% 13 37% Table 4.4 2009 AND 2008 AIR FORCE DoDSER EVENT COUNTRY EVENT COUNTRY United States 40 87% 32 91% Iraq 2 4% 0 0% Afghanistan 1 2% 0 0% Kuwait 1 2% 0 0% Korea 1 2% 0 0% Europe 1 2% 3 9% Page 74
Chapter 4 Air Force Results for Completed Suicides Event Method Figure 4.1 shows the methods Air Force decedents chose for suicide in 2009. 100 90 80 70 Percentage 60 50 40 30 20 10 0 11% 3% Firearm, military issue 57% 49% Firearm, nonmilitary issue 26% 23% 17% 17% Hanging Other 2009 2008 Figure 4.1 2009 AND 2008 AIR FORCE DoDSER EVENT METHODS Most Air Force suicides involved non-military firearms (57%, n=26), hanging (20%, n=9), and military issue firearms (11%, n=5) (Table 4.5). Methods used for the remaining suicides included sharp or blunt objects, and other methods. Table 4.5 2009 AND 2008 AIR FORCE DoDSER EVENT METHOD EVENT METHOD Drugs 1 2% 0 0% Gas, vehicle exhaust 0 0% 3 9% Gas, utility (or other) 1 2% 0 0% Hanging 9 20% 9 26% Firearm, military issue 5 11% 1 3% Firearm, non-military issue 26 57% 17 49% Sharp or blunt object 2 4% 0 0% Jumping from high place 1 2% 1 3% Other 1 2% 1 3% Don't Know 0 0% 3 9% Page 75
Chapter 4 Air Force Results for Completed Suicides Event Motivation For most decedents in 2009, the motivation behind the suicide was not known (Table 4.6). For the few instances in which a motive was identified, reasons were broadly spread to include impulsivity, emotional relief, hopelessness, and other non-defined stressors. Table 4.6 2009 AIR FORCE DoDSER EVENT MOTIVATION 2009 Count Percent EVENT MOTIVATION Emotional Relief 3 7% Influence 1 2% Individual Reasons 1 2% Hopelessness 3 7% Depression 1 2% Impulsivity 4 9% Other 3 7% Don t Know 30 65% Substance Use during the Event For 46% of Air Force suicides in 2009, data about substance use during the event were not available (Table 4.7). However, when data were available, they indicated that alcohol accompanied suicide more frequently than did drugs. Of the 25 suicides for which substance use or non-use was known, alcohol use was reported for 17 suicides and drug use was reported for six. Table 4.7 2009 AND 2008 AIR FORCE DoDSER SUBSTANCE(S) USED DURING EVENT ALCOHOL USED Yes 17 37% 9 26% No 8 17% 16 46% Don t Know 21 46% 10 29% ANY DRUGS USED Yes 6 13% 3 9% No 19 41% 21 60% Don t Know 21 46% 11 31% Illegal drugs Overdose 0 0% 0 0% Used, no overdose 0 0% 0 0% Were not used 25 54% 23 66% Don t Know 21 46% 12 34% Page 76
Chapter 4 Air Force Results for Completed Suicides Table 4.7 2009 AND 2008 AIR FORCE DoDSER SUBSTANCE(S) USED DURING EVENT (cont.) Prescription drugs Overdose 1 2% 0 0% Used, no overdose 1 2% 2 6% Were not used 23 50% 22 63% Don t Know 21 46% 11 31% OTC drugs Overdose 0 0% 0 0% Used, no overdose 4 9% 1 3% Were not used 21 46% 22 63% Don t Know 21 46% 12 34% Communication of Intent DoDSER respondents indicate the types of individuals with whom decedents communicate potential for self-harm when known. As shown in Table 4.8, 74% of Air Force decedents in 2009 had no known history of communicating a potential for self-harm prior to taking their lives. Twelve decedents reportedly had communicated their potential to one or more types of recipients prior to the suicide (Table 4.8). Six of those were reported to have expressed their intent verbally (Table 4.9). Table 4.8 2009 AND 2008 AIR FORCE DoDSER NUMBER OF TYPES OF RECIPIENTS OF COMMUNICATED INTENT NUMBER OF TYPES OF RECIPIENTS OF COMMUNICATED INTENT 0 34 74% 25 71% 1 6 13% 9 26% 2 3 7% 0 0% 3 3 7% 1 3% Table 4.9 2009 AND 2008 AIR FORCE DoDSER MODE OF COMMUNICATED INTENT MODE OF COMMUNICATED INTENT Verbal Only 6 13% 1 3% Written Only 1 2% 0 0% Other 1 2% 2 6% Multiple Modes 4 9% 0 0% Note: Multiple modes include a combination of verbal, written, or other mode of communicating intent to suicide. Page 77
Chapter 4 Air Force Results for Completed Suicides As displayed in Table 4.10, five individuals (11%) made known their intent to their spouse, four (9%) to behavioral health staff, four (9%) to a supervisor or chaplain, one to a friend, and the remaining seven (15%) to a variety of other persons (these included an ex-spouse or ex-girlfriend, and someone in the role of helping services). Note that these figures are not mutually exclusive some decedents communicated their intent to more than one type of recipient, as demonstrated in Table 4.10 and Table 4.8. In fact, 14% of Air Force decedents communicated their potential for self-harm to two or three types of recipients. Table 4.10 2009 AND 2008 AIR FORCE DoDSER RECIPIENTS OF COMMUNICATED INTENT COMMUNICATION Friend 1 2% 2 6% Behavioral Health Staff 4 9% 1 3% Supervisor 3 7% 1 3% Spouse 5 11% 0 0% Chaplain 1 2% 0 0% Other 7 15% 8 23% Made Multiple Communication 6 13% 1 3% Additional Event Information Table 4.11 shows that there was evidence that 72% (n=33) of decedents intended to die. Fourteen suicides appeared to be planned or premeditated (10 were not), and most took place where it was unlikely that others could observe or intervene (54%, n=25). A suicide note was found for 24% (n=11). As demonstrated in Table 4.11, equivalent data for 2008 were also limited. Given the limited data on this variable, comparisons with 2008 should be made with caution. Table 4.11 2009 AND 2008 AIR FORCE DoDSER OTHER EVENT INFORMATION EVIDENCE EXISTS INDICATING INTENTION TO DIE Yes 33 72% 12 34% No 2 4% 0 0% Don t Know 11 24% 23 66% DEATH RISK GAMBLING Yes 0 0% 0 0% No 33 72% 0 0% Don t Know 13 28% 35 100% PLANNED/PREMEDITATED Yes 14 30% 6 17% No 10 22% 0 0% Don t Know 22 48% 29 83% Page 78
Chapter 4 Air Force Results for Completed Suicides Table 4.11 2009 AND 2008 AIR FORCE DoDSER OTHER EVENT INFORMATION (cont.) OBSERVABLE Yes 9 20% 0 0% No 25 54% 0 0% Don t Know 12 26% 35 100% SUICIDE NOTE LEFT Yes 11 24% 0 0% No 22 48% 0 0% Don t Know 13 28% 35 100% Contextual Factors This section describes DoDSER data that pertains to situational and contextual factors such as place of residence, duty environment, and general living situation. Situational Factors As shown in Table 4.12, in 2009, Service Members who died by suicide most frequently lived in off-base family housing (63%, n=29) at the time the suicide took place. More than one-third of decedents (35%, n=16) were living with a spouse, and 24% (n=11) were living with children. A firearm was reported to be in the home or immediate environment in nearly half (46%, n=21) of suicide events. Information about situational factors such as residence was not available for the majority of suicides in 2008, precluding comparisons with the current data. Table 4.12 2009 AND 2008 AIR FORCE DoDSER HOME ENVIRONMENT RESIDENCE AT TIME OF EVENT Shared military living environment 8 17% 0 0% On-base family housing 3 7% 2 6% Owned or leased apartment or house 29 63% 11 31% Other 4 9% 1 3% MARRIED SERVICE MEMBER RESIDENCE Don t Know 2 4% 21 60% Resides with spouse 16 35% 15 43% Separated due to relationship issues 2 4% 1 3% Apart for other reasons/deployed 2 4% 0 0% Don t Know 4 9% 4 11% Unmarried at time of event 22 48% 15 43% Page 79
Chapter 4 Air Force Results for Completed Suicides Table 4.12 2009 AND 2008 AIR FORCE DoDSER HOME ENVIRONMENT (cont.) RESIDED ALONE Yes 20 43% 6 17% No 20 43% 17 49% Don t Know 6 13% 12 34% HAD MINOR CHILDREN Yes 18 39% 12 34% No 22 48% 3 9% Don t Know 6 13% 20 57% CHILDREN RESIDED WITH Yes 11 24% 11 31% No 5 11% 0 0% Don t Know 2 4% 1 3% FIREARM IN IMMEDIATE/LIVING ENVIRONMENT No Known Children 28 61% 23 66% Yes 21 46% 12 34% No 13 28% 0 0% Don t Know 12 26% 23 66% Duty Environment As shown in Table 4.13, Garrison was the most frequently reported duty environment for Air Force decedents (70%, n=32). Seven suicides occurred at various other duty locations. Four additional Service Members took their lives while on leave. Table 4.13 2009 AND 2008 AIR FORCE DoDSER DUTY ENVIRONMENT DUTY ENVIRONMENT Garrison 32 70% 27 77% Leave 4 9% 1 3% Medical Hold 1 2% 0 0% TDY 1 2% 0 0% Other 7 15% 3 9% Training 1 2% 0 0% Multiple Duty Environments Provided 5 11% 0 0% Note: Duty environment was not required for all DoDSERs. As such, percentages do not add to 100%. Page 80
Chapter 4 Air Force Results for Completed Suicides Suicide Completions by Month Consistent with data from 2008, no clear pattern exists for Air Force suicides by month (Table 4.14). Table 4.14 2009 AND 2008 AIR FORCE DoDSER SUICIDE EVENTS BY MONTH MONTH January 3 7% 4 11% February 6 13% 2 6% March 0 0% 1 3% April 6 13% 4 11% May 2 4% 1 3% June 4 9% 2 6% July 4 9% 6 17% August 3 7% 1 3% September 5 11% 4 11% October 6 13% 5 14% November 4 9% 5 14% December 3 7% 0 0% Clinical/Symptom Factors The DoDSER also captures detailed information on clinical, behavioral, and symptom factors that may be associated with subsequent suicidal behavior. These factors include data on prior self-harm, previous diagnoses of behavioral health disorders and behavioral health issues, and relevant treatment histories, including prescribed medication. Prior Self-Injury Nine decedents (20%) had histories of prior self-injury, with two of those nine known to have injured themselves more than once (Table 4.15). Page 81
Chapter 4 Air Force Results for Completed Suicides Table 4.15 2009 AND 2008 AIR FORCE DoDSER PRIOR SELF-INJURY HX PRIOR SELF-INJURY Yes 9 20% 3 9% Within 30 days 2 4% 0 0% Within 90 days (inclusive)* 3 7% 2 6% No 22 48% 0 0% Don t Know 15 33% 32 91% Number prior self-injuries One prior event 7 15% ---- ---- More than one prior event 2 4% ---- ---- N/A 37 80% ---- ---- Event similar to prior self-injury No 5 11% 0 0% Don t Know 4 9% 3 9% N/A 37 80% 32 91% Note: Number of prior self-injuries not available for 2008. *Data presented for Within 90 days includes all cases that reported the event Within 30 days. Behavioral Health Disorders Thirty-nine percent (n= 18; Table 4.16) of Air Force decedents in 2009 had a history of at least one behavioral health disorder. Specifically, mood disorders were reported for 28% of individuals in 2009, compared with 14% in 2008 (Table 4.17). Mood disorders in 2009 included four instances of major depression, one each of bipolar disorder and dysthymic disorder, and seven other undifferentiated diagnoses. Additionally, 24% of Airmen dying by suicide in 2009 had been diagnosed with an anxiety disorder (n=11) (Table 4.18). PTSD was not commonly reported (4%, n=2) and no instances of panic disorder, generalized anxiety disorder or acute stress disorder were indicated. Furthermore, Table 4.19 shows that few decedents had been diagnosed with personality disorder (4%, n=2) or had a history of substance abuse (13%, n=6), and no psychotic disorders were reported among Air Force suicides in 2009. Finally, only two individuals had been diagnosed with more than two comorbid behavioral health conditions prior to their suicides (Table 4.16). Less DoDSER data about behavioral health disorders were available in 2008 than in 2009, making comparisons between 2008 and 2009 potentially unreliable. Page 82
Chapter 4 Air Force Results for Completed Suicides Table 4.16 2009 AND 2008 AIR FORCE DoDSER COMORBIDITY RATES NUMBER OF BEHAVIORAL HEALTH DIAGNOSES No DX 28 61% 26 74% 1 DX 8 17% 9 26% 2 DX 8 17% 0 0% 3 DX 2 4% 0 0% 4 or more DX 0 0% 0 0% Table 4.17 2009 AND 2008 AIR FORCE DoDSER MOOD DISORDERS DX W/MOOD DISORDER Yes 13 28% 5 14% No 25 54% 16 46% Don t Know 8 17% 14 40% Bipolar disorder Yes 1 2% 0 0% No 36 78% 16 46% Don t Know 9 20% 19 54% Major depression Yes 4 9% 0 0% No 32 70% 16 46% Don t Know 10 22% 19 54% Dysthymic disorder Yes 1 2% 0 0% No 34 74% 16 46% Don t Know 11 24% 19 54% Other mood disorder Yes 7 15% 1 3% No 30 65% 16 46% Don t Know 9 20% 18 51% Unspecified mood disorder Yes 0 0% 4 11% No 38 83% 17 49% Don t Know 8 17% 14 40% Multiple mood DX Yes 0 0% 0 0% No 38 83% 21 60% Don t Know 8 17% 14 40% Note: Indented items were only asked in cases where the respondent indicated that the decedent had a mood disorder. Page 83
Chapter 4 Air Force Results for Completed Suicides Table 4.18 2009 AND 2008 AIR FORCE DoDSER ANXIETY DISORDERS DX W/ANXIETY DISORDER Yes 11 24% 4 11% No 26 57% 18 51% Don t Know 9 20% 13 37% PTSD Yes 2 4% 1 3% No 33 72% 18 51% Don t Know 11 24% 16 46% Panic disorder Yes 0 0% 0 0% No 35 76% 18 51% Don t Know 11 24% 17 49% Generalized anxiety disorder Yes 0 0% 0 0% No 35 76% 18 51% Don t Know 11 24% 17 49% Acute stress disorder Yes 0 0% 0 0% No 35 76% 18 51% Don t Know 11 24% 17 49% Other anxiety disorder Yes 7 15% 0 0% No 29 63% 18 51% Don t Know 10 22% 17 49% Unspecified anxiety DX Yes 2 4% 3 9% No 35 76% 19 54% Don t Know 9 20% 13 37% Multiple anxiety DX Yes 0 0% 0 0% No 37 80% 22 63% Don t Know 9 20% 13 37% Note: Indented items were only asked in cases where the respondent indicated that the decedent had an anxiety disorder. Table 4.19 2009 AND 2008 AIR FORCE DoDSER OTHER BEHAVIORAL HEALTH DISORDERS DX W/PERSONALITY DISORDER Yes 2 4% 2 6% No 33 72% 19 54% Don t Know 11 24% 14 40% DX W/PSYCHOTIC DISORDER Yes 0 0% 1 3% No 37 80% 20 57% Don t Know 9 20% 14 40% Page 84
Chapter 4 Air Force Results for Completed Suicides Table 4.19 2009 AND 2008 AIR FORCE DoDSER OTHER BEHAVIORAL HEALTH DISORDERS (cont.) HX SUBSTANCE ABUSE Yes 6 13% 7 20% No 26 57% 14 40% Don t Know 14 30% 14 40% Treatment Table 4.20 summarizes the history of Air Force decedents visits to treatment programs and clinics prior to their suicides. In 2009, 43% of decedents had been seen in a military treatment facility (MTF) within 90 days of their suicides. Ten individuals in 2009 were treated by substance abuse services compared to just two in 2008, 18 had been treated in outpatient behavioral health facilities in 2009, and eight received inpatient behavioral health treatment in 2009. Approximately 20% of decedents had received outpatient behavioral health treatment within 30 days of their suicides in both 2009 and 2008. In all of these comparisons, it is not clear how the discrepancies were influenced by the larger number of unknowns in 2008. Table 4.20 2009 AND 2008 AIR FORCE DoDSER TREATMENT HISTORY SEEN AT MILITARY TREATMENT FACILITY Yes 28 61% 17 49% Within 30 days 15 33% 3 9% Within 90 days (inclusive)* 20 43% 7 20% No 7 15% 6 17% Don t Know 11 24% 12 34% SUBSTANCE ABUSE SERVICES Yes 10 22% 2 6% Within 30 days 5 11% 1 3% Within 90 days (inclusive)* 5 11% 1 3% No 28 61% 19 54% Don t Know 8 17% 14 40% FAMILY ADVOCACY PROGRAMS Yes 3 7% 3 9% Within 30 days 0 0% 1 3% Within 90 days (inclusive)* 1 2% 2 6% No 33 72% 18 51% Don t Know 10 22% 14 40% Page 85
Chapter 4 Air Force Results for Completed Suicides Table 4.20 2009 AND 2008 AIR FORCE DoDSER TREATMENT HISTORY (cont.) CHAPLAIN SERVICES Yes 5 11% 3 9% Within 30 days 2 4% 1 3% Within 90 days (inclusive)* 3 7% 3 9% No 11 24% 18 51% Don t Know 30 65% 14 40% OUTPATIENT BEHAVIORAL HEALTH Yes 18 39% 9 26% Within 30 days 10 22% 7 20% Within 90 days (inclusive)* 11 24% 8 23% No 21 46% 12 34% Don t Know 7 15% 14 40% INPATIENT BEHAVIORAL HEALTH Yes 8 17% 0 0% Within 30 days 0 0% 0 0% Within 90 days (inclusive)* 1 2% 0 0% No 28 61% 12 34% Don t Know 10 22% 23 66% HX PHYSICAL HEALTH PROBLEM Yes 16 35% 6 17% Within 30 days 6 13% 1 3% Within 90 days (inclusive)* 8 17% 4 11% No 17 37% 8 23% Don t Know 13 28% 21 60% *Data presented for Within 90 days includes all cases that reported the event Within 30 days. Therefore, summing the two time frames sums to more than the total number of cases in some instances. Table 4.21 shows psychotropic medications used by individuals prior to suicide. Definitive data were available for 76% of decedents in 2009 but for only 29% of decedents in 2008. In 2009, 10 decedents were reported to have used psychotropic drugs while 25 were known to have not. All 10 had reportedly used antidepressants, whereas use of antianxiety medications, anticonvulsants, and antipsychotics was rare. Table 4.21 2009 AND 2008 AIR FORCE DoDSER PSYCHOTROPIC MEDICATION USE TAKEN PSYCHOTROPIC MEDS Yes 10 22% 1 3% No 25 54% 9 26% Don t Know 11 24% 25 71% Page 86
Chapter 4 Air Force Results for Completed Suicides Table 4.21 2009 AND 2008 AIR FORCE DoDSER PSYCHOTROPIC MEDICATION USE (cont.) Antidepressants Yes 10 22% 1 3% No 25 54% 9 26% Don t Know 11 24% 25 71% Antianxiety Yes 3 7% 0 0% No 31 67% 10 29% Don t Know 12 26% 25 71% Antimanics Yes 0 0% 0 0% No 34 74% 10 29% Don t Know 12 26% 25 71% Anticonvulsants Yes 1 2% 0 0% No 33 72% 10 29% Don t Know 12 26% 25 71% Antipsychotics Yes 2 4% 0 0% No 33 72% 10 29% Don t Know 11 24% 25 71% Note: Indented items were only asked in cases where the respondent indicated that the decedent used psychotropic medication. Historical/Developmental Factors DoDSER data are collected on historical or developmental factors that precede a suicide event. These data include information about family histories and interpersonal relationships, legal, financial and administrative difficulties, and reports of prior abuse. Family and Relationship History A history of a failed or failing spousal or intimate relationship was commonly reported for Air Force suicides in 2009 (Table 4.22). Failures of intimate relationships were known to have occurred prior to 26 suicides. Of those 26, 11 were known to have experienced a failed spousal relationship within 30 days of suicide, and another four within 90 days of suicide. Other possible family and relationship factors, such as the death or suicide of a spouse, family or friend, appear to be rare (Table 4.23). Page 87
Chapter 4 Air Force Results for Completed Suicides Table 4.22 2009 AND 2008 AIR FORCE DoDSER RELATIONSHIP HISTORY HX FAILED INTIMATE RELATIONSHIP Yes 26 57% 14 40% Within 30 days 11 24% 3 9% Within 90 days (inclusive)* 15 33% 14 40% No 11 24% 6 17% Don t Know 9 20% 15 43% HX FAILED OTHER RELATIONSHIP Yes 3 7% 7 20% Within 30 days 2 4% 0 0% Within 90 days (inclusive)* 2 4% 6 17% No 22 48% 7 20% Don t Know 21 46% 21 60% HX ANY FAILED RELATIONSHIP Yes 26 57% 15 43% Within 30 days 11 24% 3 9% Within 90 days (inclusive)* 15 33% 14 40% No 11 24% 5 14% Don t Know 9 20% 15 43% *Data presented for Within 90 days includes all cases that reported the event Within 30 days. Therefore, summing the two time frames sums to more than the total number of cases in some instances. Table 4.23 2009 AND 2008 AIR FORCE DoDSER FAMILY HISTORY HX SPOUSE SUICIDE Yes 0 0% 0 0% No 35 76% 1 3% Don t Know 11 24% 34 97% HX FAMILY MEMBER SUICIDE Yes 3 7% 0 0% No 23 50% 0 0% Don t Know 20 43% 35 100% HX FRIEND SUICIDE Yes 2 4% 0 0% No 19 41% 0 0% HX DEATH OF SPOUSE/FAMILY MEMBER Don t Know 25 54% 35 100% Yes 3 7% 1 3% No 17 37% 0 0% Don t Know 26 57% 34 97% Page 88
Chapter 4 Air Force Results for Completed Suicides Table 4.23 2009 AND 2008 AIR FORCE DoDSER FAMILY HISTORY (cont.) HX DEATH OF FRIEND Yes 1 2% 0 0% No 18 39% 0 0% Don t Know 27 59% 35 100% HX SPOUSE/FAMILY ILLNESS Yes 2 4% 0 0% No 21 46% 0 0% HX FAMILY BEHAVIORAL HEALTH PROBLEMS Don t Know 23 50% 35 100% Yes 7 15% 1 3% No 14 30% 0 0% Don t Know 25 54% 34 97% Administrative and Legal History A history of legal or administrative problems before an Air Force suicide was relatively uncommon (Table 4.24). Few instances of courts martial, Article 15 proceedings, administrative separations, absences without leave, medical evaluation board reviews, or job selection or promotion concerns were reported. Civil legal problems (e.g., child custody, litigation) were the most prevalent legal issues reported to have occurred prior to suicides (15%, n=7). Table 4.24 2009 AND 2008 AIR FORCE DoDSER ADMIN/LEGAL HISTORY HX COURTS MARTIAL Yes 2 4% 0 0% No 33 72% 19 54% Don t Know 11 24% 16 46% HX ARTICLE 15 Yes 5 11% 2 6% No 28 61% 18 51% Don t Know 13 28% 15 43% HX ADMIN SEPARATION Yes 1 2% 0 0% No 33 72% 10 29% Don t Know 12 26% 25 71% HX AWOL Yes 1 2% 0 0% No 33 72% 9 26% Don t Know 12 26% 26 74% HX MEDICAL BOARD Yes 4 9% 0 0% No 33 72% 4 11% Don t Know 9 20% 31 89% Page 89
Chapter 4 Air Force Results for Completed Suicides Table 4.24 2009 AND 2008 AIR FORCE DoDSER ADMIN/LEGAL HISTORY (cont.) HX CIVIL LEGAL PROBLEMS Yes 7 15% 1 3% No 24 52% 16 46% Don t Know 15 33% 18 51% HX NON-SELECTION Yes 5 11% 0 0% No 26 57% 0 0% Don t Know 15 33% 35 100% Abuse History A history of physical, sexual or emotional abuse, either as a victim or perpetrator, was not commonly reported for Air Force Service Members taking their lives (Table 4.25). Most notably, there were five known instances of decedents who were perpetrators of physical abuse. Table 4.25 2009 AND 2008 AIR FORCE DoDSER ABUSE HISTORY HX VICTIM PHYSICAL ABUSE Yes 2 4% 0 0% No 30 65% 0 0% Don t Know 14 30% 35 100% HX VICTIM SEXUAL ABUSE Yes 1 2% 0 0% No 31 67% 0 0% Don t Know 14 30% 35 100% HX VICTIM EMOTIONAL ABUSE Yes 3 7% 0 0% No 29 63% 0 0% Don t Know 14 30% 35 100% HX VICTIM SEXUAL HARASSMENT Yes 0 0% 0 0% No 30 65% 0 0% Don t Know 16 35% 35 100% HX PERPETRATOR PHYSICAL ABUSE Yes 5 11% 0 0% No 23 50% 0 0% Don t Know 18 39% 35 100% HX PERPETRATOR SEXUAL ABUSE Yes 2 4% 0 0% No 25 54% 0 0% Don t Know 19 41% 35 100% HX PERPETRATOR EMOTIONAL ABUSE Yes 0 0% 0 0% No 25 54% 0 0% Don t Know 21 46% 35 100% Page 90
Chapter 4 Air Force Results for Completed Suicides Table 4.25 2009 AND 2008 AIR FORCE DoDSER ABUSE HISTORY (cont.) HX PERPETRATOR SEXUAL HARASSMENT Yes 1 2% 0 0% No 25 54% 0 0% Don t Know 20 43% 35 100% Financial and Workplace Difficulties A small proportion of Air Force decedents in 2009 (4 of 29 with available financial data) were reported to have had excessive debt or bankruptcy compared with the previous year (7 of 15 known for 2008). Table 4.26 shows that job loss or job instability preceding suicide was the most prevalent financial or workplace difficulty reported (30%, n=14). Supervisory or co-worker issues and poor work performance reviews were less frequently reported. Table 4.26 2009 AND 2008 AIR FORCE DoDSER FINANCIAL AND WORKPLACE DIFFICULTIES EXCESSIVE DEBT/BANKRUPTCY Yes 4 9% 7 20% No 25 54% 8 23% Don t Know 17 37% 20 57% HX JOB PROBLEMS Yes 14 30% 8 23% No 19 41% 11 31% Don t Know 13 28% 16 46% HX SUPERVISOR/COWORKER ISSUES Yes 4 9% 0 0% No 26 57% 0 0% Don t Know 16 35% 35 100% HX POOR WORK EVALUATION Yes 7 15% 2 6% No 25 54% 3 9% Don t Know 14 30% 30 86% HX UNIT/WORKPLACE HAZING Yes 0 0% 0 0% No 29 63% 0 0% Don t Know 17 37% 35 100% Deployment Factors The 2009 DoDSER captured detailed information pertaining to the Service Member s most recent three deployments. Data include deployment location information as well as a history of direct combat operations. Comparisons of Operation Enduring Freedom/Operation Iraqi Freedom (OEF/OIF) suicide events to non-oef/oif suicide events are reported in Chapter 3. Page 91
Chapter 4 Air Force Results for Completed Suicides Deployment and Combat History Ten (22%) of the Air Force Service Members who died by suicide in 2009 had served in Afghanistan or Iraq (Table 4.27), and few reported combat experiences (Table 4.28). Table 4.27 2009 AND 2008 AIR FORCE DoDSER EVER DEPLOYED TO OEF/OIF HX DEPLOYMENT OEF/OIF AFGHANISTAN 4 9% 0 0% IRAQ 6 13% 0 0% KUWAIT 2 4% 0 0% MULTIPLE OEF/OIF LOCATIONS 1 2% 0 0% NO HX OEF/OIF DEPLOYMENT 33 72% 35 100% Table 4.28 2009 AND 2008 AIR FORCE DoDSER COMBAT HISTORY COMBAT HISTORY HX DIRECT COMBAT 3 7% 0 0% Combat Resulted in Injuries/Casualties 2 67% 0 0% Injured in Combat 1 33% 0 0% Witnessed Killing in Combat 2 67% 0 0% Saw Dead Bodies in Combat 1 33% 0 0% NO DIRECT COMBAT HX 43 93% 35 100% Note: Indented items were only asked in cases for which the respondent indicated that the decedent had participated in direct combat. Percentages for these items reflect proportion of those with combat experience. Page 92
Chapter 4 Air Force Results for Completed Suicides Summary This annual report of the Air Force DoDSER provides data on Air Force suicides that occurred in 2009. An Air Force DoDSER was submitted for all suicides for 2009 (n=46). This report also includes equivalent data from the 2008 Air Force DoDSER Annual Report. Reliable comparisons between the two years are difficult because of the low number of suicides in each year and because of the substantial numbers of DoDSER items for which details were not known or were unavailable, especially in 2008. Consequently, interpretations of the data presented here must be made with particular caution. Suicides in 2009 were most common among young, Caucasian, married, enlisted, active component Service Members. Firearms (both non-military and military-issue) and hanging were the most frequent methods of suicide. In most instances, the motivations behind the suicides were not known, and few decedents were reported to have communicated their intent to others. Off-base housing was the most common place of residence at the time of suicide in 2009. Suicides most frequently occurred in Service Members personal residences or barracks. Sixty-one percent of decedents had been seen in an MTF prior to taking their lives, including 43% within three months of their suicides. Behavioral health histories were reported for approximately one-fourth of suicides, with mood and anxiety disorders most commonly reported. The most frequently reported stressors included failed or failing spousal or other intimate relationships, and job related problems. Ten of the 46 decedents had a history of deployment to OEF/OIF, and few reported combat experiences. Page 93
Chapter 5 ARMY RESULTS Army Results for Completed Suicides This chapter presents a summary of calendar year 2009 Army Department of Defense Suicide Event Report (DoDSER) data. Data collection processes following a suicide are described in Chapter 1, Method. The Army DoDSER chapter for 2009 contains more information than do the other Services DoDSER chapters. This is because the Army s previous system, the Army Suicide Event Report (ASER), captured data on non-fatal suicide events (attempts, self-harm, suicidal ideation) in addition to data on suicide completions. This system was seamlessly transferred to the new DoDSER in 2008, providing additional data to analyze (data regarding non-fatal 2009 Army events are provided in the Army Results for Non- Fatal Events section of this chapter, page 117). All of the Services began collecting data on suicide attempts by 1 January 2010, which will be available in the 2010 DoDSER Annual Report. Army DoDSER Submissions for Completed Suicides, and POC Compliance Table 5.1 shows the number of Armed Forces Medical Examiner System (AFMES) confirmed Army suicides for 2009, and the compliance rate for Army DoDSER submissions at the time of this report. As shown below, 161 suicide cases were confirmed by the AFMES as of 31 January 2010, and 153 Army DoDSERs were submitted, for a compliance rate of 95%. Table 5.1 2009 ARMY AFMES CONFIRMED AND PENDING SUICIDES AND DoDSERs SUBMITTED 2009 Total DoDSERs 153 Total AFMES Confirmed and Pending Suicides 164 AFMES Confirmed Suicides (as of 31 JAN 2010) 161 DoDSER Submission Compliance 95% Additional DoDSERs Pending AFMES Confirmation 0 Data from 1/1/2009 through 12/31/2009 as of 4/1/2010 Dispositional/Personal Factors This section reports data that describe internal characteristics or individual behaviors of decedents that may have been associated with or contributed to the suicidal events. These factors include decedents demographic characteristics, event setting, suicide method, substance use during the event, potential motives and intent to die, and communication of potential for self-harm. Page 94
Chapter 5 Army Results Demographics Table 5.2 summarizes demographic data for Army suicides for 2009. The majority of decedents were Caucasian (79%, n=130), under 25 years of age (43%, n=71), married (51%, n=83), and lower enlisted (57%, n=94). The highest level of education for the majority of decedents was high school graduate or GED (General Equivalency Diploma) (79%, n=130). As shown, the demographic characteristics of decedents in 2009 were very similar to suicide decedents in 2008. Table 5.2 2009 AND 2008 AFMES ARMY DEMOGRAPHICS GENDER Male 159 97% 132 94% Female 5 3% 8 6% RACE Asian/Pacific Islander 10 6% 7 5% African American 19 12% 20 14% Caucasian 130 79% 109 78% American Indian/Alaska Native 5 3% 1 1% Other/Don t Know/Missing 0 0% 6 13% AGE RANGE Under 25 71 43% 70 50% 25-29 49 30% 22 16% 30-39 33 21% 30 21% 40 + 11 6% 18 13% RANK E1-E4 94 57% 78 56% E5-E9 51 31% 46 33% Officer 15 9% 13 9% Warrant Officer 2 1% 2 1% Cadet/Midshipman 0 0% 1 1% COMPONENT Regular 147 90% 116 83% Reserve 3 2% 8 6% National Guard 14 9% 16 11% EDUCATION Did not graduate high school 2 1% 4 3% GED 34 21% 22 16% High school graduate 96 59% 81 58% Some college or technical school 11 7% 0 0% Degree/certificate of less than four years 3 2% 15 11% Four-year college degree 12 7% 10 7% Master s degree or greater 4 2% 8 6% Don t Know 2 1% 0 0% Page 95
Chapter 5 Army Results Table 5.2 2009 AND 2008 AFMES ARMY DEMOGRAPHICS (cont.) MARITAL STATUS Never Married 58 35% 54 39% Married 83 51% 77 55% Legally Separated 0 0% 0 0% Divorced 22 13% 8 6% Widowed 1 1% 0 0% Don t Know 0 0% 1 1% Note: Demographic data were obtained from the DMDC with assistance from the AFMES and reflect suicide events from 1/1/2008 through 12/31/2009 as of 4/1/2010. As such, the total indicated above (n=164) is higher than the total used throughout the remainder of this chapter (n=153). Event Setting Table 5.3 displays the DoDSER data regarding the countries where the suicides occurred. The AFMES reported 23 OIF suicides and 6 OEF pending and confirmed Army suicides as of 1 April 2010. DoDSER data provide a description of the event country for all events, although DoDSERs were not received for all suicides, as noted in Chapter 2. DoDSER data shows that seventy-three percent (n=112) occurred in the United States, and very few occurred during deployment. Of those occurring overseas, the majority occurred in Iraq or Europe. Table 5.3 2009 AND 2008 ARMY DoDSER EVENT COUNTRY FOR COMPLETED SUICIDES EVENT COUNTRY United States 112 73% 90 71% Iraq 22 14% 25 20% Afghanistan 3 2% 7 6% Kuwait 0 0% 1 1% Korea 5 3% 0 0% Europe 7 5% 2 2% Canada 1 1% 0 0% Other 2 1% 0 0% Don't Know 1 1% 1 1% Note: Data differs from AFMES OEF/OIF counts due to missing DoDSERs. As shown in Table 5.4, suicides most commonly occurred in the personal residences of Soldiers (58%, n=89), followed by friend or family member residences (9%, n=14). Twenty-two percent of suicides were Page 96
Chapter 5 Army Results completed in other settings including an interstate, latrine, movie theater, parking garage, pasture, and an unoccupied building, with the most commonly reported other setting being a hotel room. Table 5.4 2009 AND 2008 ARMY DoDSER EVENT SETTING FOR COMPLETED SUICIDES EVENT SETTING Residence (own) or barracks 89 58% 74 59% Residence of friend or family 14 9% 10 8% Work/jobsite 8 5% 11 9% Automobile (away from residence) 9 6% 7 6% Inpatient medical facility 0 0% 1 1% Other 33 22% 23 18% Event Method Figure 5.1 and Table 5.5 show the methods decedents used to end their lives. Firearms were the most commonly reported suicide method (19%, n=29 for military firearm; 40%, n=61 for non-military firearm; 59%, n=90 for total combined), followed by hanging 22% (n=33). 100 90 80 70 Percentage 60 50 40 30 28% 39% 40% 2009 2008 20 19% 21% 20% 16% 17% 10 0 Firearm, military issue Firearm, nonmilitary issue Hanging Other Figure 5.1 2009 AND 2008 ARMY DoDSER EVENT METHODS Page 97
Chapter 5 Army Results Table 5.5 2009 AND 2008 ARMY DoDSER EVENT METHOD FOR COMPLETED SUICIDES EVENT METHOD Drugs 8 5% 10 8% Alcohol 1 1% 1 1% Gas, vehicle exhaust 7 5% 1 1% Gas, utility (or other) 2 1% 1 1% Hanging 33 22% 19 15% Firearm, military issue 29 19% 35 28% Firearm, non-military issue 61 40% 51 40% Fire, steam, etc. 0 0% 1 1% Sharp or blunt object 1 1% 0 0% Jumping from high place 2 1% 2 2% Lying in front of moving object 2 1% 0 0% Other 6 4% 1 1% Don't Know 1 1% 4 3% Event Motivation After reviewing all relevant records and conducting interviews, the Army DoDSER respondents reviewed available evidence and made a subjective assessment of the decedent s primary motivation for the suicide. It is important to note that such reporting attempts to simplify extremely complex behavior. Due to the subjectivity of the content, results should be interpreted with caution. As shown in Table 5.6, 18% (n=28) of decedents reportedly ended their lives because they sought emotional relief (e.g., to stop bad feelings or self-hatred, to relieve anxiety). This was the most commonly cited motivation, followed by feelings of hopelessness (10%, n=15). These proportions are similar to those reported for 2008 suicides. Other reported event motivations included pending investigation and disciplinary action, failing relationships, accidental shooting, and the sense that there was no other choice. Suicide motivation was not reported for nearly half of the decedents. Page 98
Chapter 5 Army Results Table 5.6 2009 AND 2008 ARMY DoDSER EVENT MOTIVATION FOR COMPLETED SUICIDES EVENT MOTIVATION Emotional Relief 28 18% 26 21% Influence 0 0% 4 3% Avoidance 4 3% 15 12% Individual Reasons 7 5% 3 2% Hopelessness 15 10% 12 10% Depression 7 5% 5 4% Other Psychiatric 4 3% 3 2% Impulsivity 13 8% 11 9% Other 8 5% 10 8% Don't Know 67 44% 37 29% Substance Use during the Event The DoDSER process captures information about whether alcohol or other drugs were used during the suicide (not necessarily as a method for suicide). As shown in Table 5.7, 22% (n=33) of Soldiers were reported to have used alcohol during suicide. A much smaller proportion was reported to have used drugs, including OTC and prescription medications. These percentages may be underestimates, as no information was reported in a significant proportion of the cases, presumably because autopsy results were not available at the time of the Army DoDSER submissions. Table 5.7 2009 AND 2008 ARMY DoDSER SUBSTANCE(S) USED DURING EVENT FOR COMPLETED SUICIDES ALCOHOL USED Yes 33 22% 26 21% No 60 39% 47 37% Don t Know 60 39% 53 42% ANY DRUGS USED Yes 9 6% 11 9% No 71 46% 55 44% Don t Know 73 48% 60 48% Illegal drugs Overdose 0 0% 1 1% Used, no overdose 1 1% 0 0% Were not used 79 52% 62 49% Don t Know 73 48% 63 50% Page 99
Chapter 5 Army Results Table 5.7 2009 AND 2008 ARMY DoDSER SUBSTANCE(S) USED DURING EVENT FOR COMPLETED SUICIDES (cont.) Prescription drugs Overdose 6 4% 11 9% Used, no overdose 0 0% 0 0% Were not used 74 48% 55 44% Don t Know 73 48% 60 48% OTC drugs Overdose 2 1% 4 3% Used, no overdose 0 0% 1 1% Were not used 78 51% 58 46% Don t Know 73 48% 63 50% BOTH ALCOHOL AND DRUGS USED Yes 2 1% 2 2% No 75 49% 63 50% Don t Know 76 50% 61 48% Communication of Intent DoDSER respondents indicate the types of individuals with whom decedents communicated potential for self-harm when known. As shown in Table 5.8, 29% of Soldiers (n=45) who died by suicide were reported to have communicated their potential for self-harm prior to taking their lives. Fifteen Soldiers (10%) who died by suicide reportedly communicated their potential for self-harm to multiple people. These percentages may be an underestimate, as it is possible that some Soldiers did communicate their potential for self-harm, but this information might not have been available to the DoDSER respondent. The majority of Army decedents were not reported to have disclosed their suicidal intent (71%, n=108). Of decedents who did communicate intent for self-harm, the majority (20%, n=30) expressed this intent to one recipient. A much smaller proportion (7%, n=10) communicated intent for self-harm to two recipients (Table 5.8). Table 5.8 2009 AND 2008 ARMY DoDSER NUMBER OF TYPES OF RECIPIENTS OF COMMUNICATED INTENT FOR COMPLETED SUICIDES NUMBER OF TYPES OF RECIPIENTS OF COMMUNICATED INTENT 0 108 71% 91 72% 1 30 20% 22 17% 2 10 7% 9 7% 3 2 1% 4 3% 4 2 1% 0 0% 5 1 1% 0 0% Page 100
Chapter 5 Army Results As indicated in Table 5.9, decedents most commonly shared their intent with their spouses (13%, n=20) and friends (11%, n=17). Other individuals or groups with whom decedents were reported to have communicated suicidal intent include a blog community, mothers and other relatives, members of their command, their unit, and patrons at a community center. Table 5.9 2009 AND 2008 ARMY DoDSER RECIPIENTS OF COMMUNICATED INTENT FOR COMPLETED SUICIDES COMMUNICATION Friend 17 11% 11 9% Behavioral Health Staff 9 6% 7 6% Supervisor 7 5% 5 4% Spouse 20 13% 17 13% Chaplain 3 2% 3 2% Other 13 8% 9 7% Made Multiple Communication 15 10% 13 10% Table 5.10 displays the modes of communication of suicidal intent. As shown, the majority of communications were verbal. Other methods of communication included instant messaging, blogging, MySpace posting, through previous self-harm behaviors, and text messaging. In a significant proportion of cases there was no known communication of intent. Table 5.10 2009 AND 2008 ARMY DoDSER MODE OF COMMUNICATED INTENT FOR COMPLETED SUICIDES MODE OF COMMUNICATED INTENT Verbal Only 26 17% 26 21% Written Only 6 4% 1 1% Other 11 7% 1 1% Multiple Modes 3 2% 8 6% Note: Multiple Modes includes a combination of verbal, written, or other mode of communicating intent to suicide. Additional Event Information Additional details about Army suicides were consistent from 2008 to 2009. As shown in Table 5.11, most decedents were reported to have intended to die (76%, n=117), but only 42% (n=65) of the suicides were deemed to have been premeditated. The majority of decedents (69%, n=106) reportedly took their lives in places where it was unlikely that others could observe or intervene, and in most cases (54%, n=82) no suicide note was found. Page 101
Chapter 5 Army Results Table 5.11 2009 AND 2008 ARMY DoDSER OTHER EVENT INFORMATION FOR COMPLETED SUICIDES INTENDED TO DIE Yes 117 76% 106 84% No 10 7% 7 6% Don't Know 26 17% 13 10% DEATH RISK GAMBLING Yes 3 2% 2 2% No 133 87% 101 80% Don't Know 17 11% 23 18% PLANNED/PREMEDITATED Yes 65 42% 54 43% No 47 31% 40 32% Don't Know 41 27% 32 25% OBSERVABLE Yes 35 23% 29 23% No 106 69% 84 67% Don't Know 12 8% 13 10% SUICIDE NOTE LEFT Yes 38 25% 34 27% No 82 54% 62 49% Don't Know 33 22% 30 24% Contextual Factors This section describes DoDSER data that pertains to contextual factors such as the home and duty environments. Home Environment Items pertaining to the individual s situation at the time of suicide, such as residence, living situation, presence of minor children in the home, and firearms in the immediate living environment are shown in Table 5.12. For the majority of suicides (42%, n=64), decedents resided in barracks or similar shared military housing. Owned or leased apartments or homes were the second most prevalent response (39%, n=59). Twenty percent (n=31) of suicide decedents were reported to have lived with a spouse, whereas the majority, 53% (n=81) were reported as having been unmarried at the time of the event. Thirty-three percent (n=50) of decedents were reported to have lived alone at the time of the suicide. Forty percent (n=61) of decedents reportedly had minor children; the majority did not live with their children at the time of the event. Access to a firearm was reported for 52% (n=79) of completed suicides. Page 102
Chapter 5 Army Results Table 5.12 2009 AND 2008 ARMY DoDSER HOME ENVIRONMENT FOR COMPLETED SUICIDES RESIDENCE AT TIME OF EVENT Shared military living environment 64 42% 59 47% Bachelor quarters 1 1% 0 0% On-base family housing 7 5% 5 4% Owned or leased apartment or house 59 39% 46 37% Other 16 10% 9 7% Don't Know 6 4% 7 6% MARRIED SERVICE MEMBER Resides with spouse 31 20% 24 19% RESIDENCE Separated due to relationship issues 18 12% 17 13% Apart for other reasons/deployed 18 12% 16 13% Don't Know 5 3% 2 2% Unmarried at time of event 81 53% 67 53% RESIDED ALONE Yes 50 33% 35 28% No 84 55% 72 57% Don't Know 19 12% 19 15% HAD MINOR CHILDREN Yes 61 40% 42 33% No 71 46% 59 47% Don't Know 21 14% 25 20% CHILDREN RESIDED WITH Yes 22 14% 14 11% No 37 24% 27 21% Don't Know 2 1% 1 1% No Children 92 60% 84 67% FIREARM IN IMMEDIATE/LIVING Yes 79 52% 80 63% ENVIRONMENT No 37 24% 13 10% Don't Know 37 24% 33 26% Duty Environment Data pertaining to the duty environments associated with Army suicides are presented in Table 5.13. Garrison was by far the most commonly reported duty environment for decedents in 2009, (59%, n=91). Twelve percent (n=18) of suicides were reportedly completed while Soldiers were on leave. Page 103
Chapter 5 Army Results Table 5.13 2009 AND 2008 ARMY DoDSER DUTY ENVIRONMENT FOR COMPLETED SUICIDES DUTY ENVIRONMENT Garrison 91 59% 63 50% Psych Hosp 1 1% 1 1% Leave 18 12% 13 10% Medical Hold 3 2% 3 2% TDY 1 1% 0 0% Evacuation Chain 0 0% 1 1% AWOL 7 5% 3 2% Under Command Observation 1 1% 1 1% Other 12 8% 9 7% Training 6 4% 3 2% Multiple Duty Environments Provided 13 8% 6 5% Note: Duty environment was not required for all DoDSERs. As such, percentages do not add to 100%. Suicide Completions by Month Consistent with data from 2008, no clear pattern exists for Army suicides by month, as shown in Table 5.14. Table 5.14 2009 AND 2008 ARMY DoDSER SUICIDE EVENTS BY MONTH FOR COMPLETED SUICIDES MONTH January 19 12% 5 4% February 20 13% 11 9% March 12 8% 10 8% April 9 6% 12 10% May 18 12% 8 6% June 8 5% 12 10% July 12 8% 10 8% August 10 7% 13 10% September 7 5% 12 10% October 19 12% 11 9% November 10 7% 12 10% December 9 6% 10 8% Page 104
Clinical/Symptom Factors DoDSER 2009 Annual Report Chapter 5 Army Results The DoDSER also captures detailed information on clinical, behavioral, and symptom factors that may be associated with subsequent suicidal behavior. These factors include data on prior self-harm, previous diagnoses of behavioral health disorders and behavioral health issues, and relevant treatment histories, including prescribed medication. Prior Self-Injury As shown in Table 5.15, 20% (n=30) of Army decedents had a reported history of prior self-injury. Nine percent (n=14) were reported to have had more than one previous incident of self-injury. Seven percent of decedents had a known prior self-injury event within 90 days of death. Table 5.15 2009 AND 2008 ARMY DoDSER PRIOR SELF-INJURY FOR COMPLETED SUICIDES HX PRIOR SELF-INJURY Yes 30 20% 20 16% Within 30 days 6 4% 2 2% Within 90 days (inclusive)* 11 7% 4 3% No 87 57% 65 52% Don t Know 36 24% 41 33% Number prior self-injuries One prior event 16 10% ---- ---- More than one prior event 14 9% ---- ---- N/A 123 80% ---- ---- Event similar to prior self-injury Yes 5 3% 2 2% No 19 12% 16 13% Don t Know 6 4% 2 2% N/A 123 80% 106 84% Note: Number of prior self-injuries not available for 2008. *Data presented for Within 90 days includes all cases that reported the event Within 30 days. Behavioral Health Disorders Table 5.16, Table 5.17 and Table 5.18 contain information on the types of behavioral health disorders reported for decedents. As displayed in Table 5.16, 28% (n=43) of decedents had been diagnosed with a mood disorder, including major depression (n=21), dysthymic disorder (n=2), and bipolar disorder (n=1). Nineteen percent (n=29) had been diagnosed with an anxiety disorder, including PTSD (9%, n=14; Table 5.17). Two decedents had been diagnosed with a psychotic disorder and seven had personality disorder diagnoses. Nearly a quarter of decedents (23%, n=35) had a history of substance abuse (Table 5.18). Page 105
Chapter 5 Army Results Table 5.16 2009 AND 2008 ARMY DoDSER MOOD DISORDERS FOR COMPLETED SUICIDES DX W/MOOD DISORDER Yes 43 28% 32 25% No 94 61% 69 55% Don t Know 16 10% 25 20% Bipolar disorder Yes 1 1% 2 2% No 132 86% 96 76% Don t Know 20 13% 28 22% Major depression Yes 21 14% 10 8% No 114 75% 90 71% Don t Know 18 12% 26 21% Dysthymic disorder Yes 2 1% 1 1% No 131 86% 98 78% Don t Know 20 13% 27 21% Other mood disorder Yes 5 3% 17 13% No 127 83% 81 64% Don t Know 21 14% 28 22% Unspecified mood disorder Yes 6 4% 0 0% No 131 86% 101 80% Don t Know 16 10% 25 20% Multiple mood DX Yes 8 5% 2 2% No 129 84% 99 79% Don t Know 16 10% 25 20% Note: Indented items were only asked in cases where the respondent indicated that the decedent had a mood disorder. Table 5.17 2009 AND 2008 ARMY DoDSER ANXIETY DISORDERS FOR COMPLETED SUICIDES DX W/ ANXIETY DISORDER Yes 29 19% 15 12% No 105 69% 85 67% Don't Know 19 12% 26 21% PTSD Yes 14 9% 5 4% No 119 78% 93 74% Don't Know 20 13% 28 22% Panic disorder Yes 0 0% 1 1% No 132 86% 96 76% Don't Know 21 14% 29 23% Page 106
Chapter 5 Army Results Table 5.17 2009 AND 2008 ARMY DoDSER ANXIETY DISORDERS FOR COMPLETED SUICIDES (cont.) Generalized anxiety disorder Yes 2 1% 0 0% No 131 86% 96 76% Don't Know 20 13% 30 24% Acute stress disorder Yes 0 0% 0 0% No 132 86% 96 76% Don't Know 21 14% 30 24% Other anxiety disorder Yes 6 4% 5 4% No 125 82% 91 72% Don't Know 22 14% 30 24% Unspecified anxiety DX Yes 2 1% 1 1% No 132 86% 99 79% Don't Know 19 12% 26 21% Multiple anxiety DX Yes 5 3% 3 2% No 129 84% 97 77% Don't Know 19 12% 26 21% Note: Indented items were only asked in cases where the respondent indicated that the decedent had an anxiety disorder. Table 5.18 2009 AND 2008 ARMY DoDSER OTHER BEHAVIORAL HEALTH DISORDERS FOR COMPLETED SUICIDES DX W/PERSONALITY DISORDER Yes 7 5% 8 6% No 126 82% 89 71% Don t Know 20 13% 29 23% DX W/PSYCHOTIC DISORDER Yes 2 1% 1 1% No 132 86% 99 79% Don t Know 19 12% 26 21% HX SUBSTANCE ABUSE Yes 35 23% 30 24% No 91 59% 68 54% Don t Know 27 18% 28 22% As shown in Table 5.19, slightly more than half of the decedents (54%, n=83) had no reported behavioral health diagnoses. Twenty-three percent (n=35) had at least one documented behavioral health diagnosis, 13% (n=20) had two, 5% (n=8) had three, and an additional 5% (n=7) had four or more documented behavioral health diagnoses. Page 107
Chapter 5 Army Results Table 5.19 2009 AND 2008 ARMY DoDSER COMORBIDITY RATES FOR COMPLETED SUICIDES NUMBER OF BEHAVIORAL HEALTH DIAGNOSES No DX 83 54% 76 60% 1 DX 35 23% 31 25% 2 DX 20 13% 9 7% 3 DX 8 5% 8 6% 4 or more DX 7 5% 2 2% Treatment Table 5.20 shows the history of Army decedents visits to treatment programs and clinics prior to taking their lives. DoDSER respondents were instructed to select all categories that apply, thus categories are not mutually exclusive. Fifty-three percent (n=81) of decedents had been seen in military treatment facilities (MTFs) within 90 days of suicide, and 40% (n=61) within 30 days. Thirty-two percent (n=48) of decedents had been seen in outpatient behavioral health facilities within 90 days of suicide. Nineteen percent (n=29) of decedents were reported to have been admitted to inpatient behavioral health facilities prior to suicide. Table 5.20 also provides information about the history of decedents visits to other broadly-defined behavioral health resources (i.e., Chaplain, Family Advocacy Program, Army Substance Abuse Program) within 30 and 90 days of suicide. Table 5.20 2009 AND 2008 ARMY DoDSER TREATMENT HISTORY FOR COMPLETED SUICIDES SEEN AT MILITARY TREATMENT Yes 95 62% 75 60% FACILITY Within 30 days 61 40% 49 39% Within 90 days (inclusive)* 81 53% 63 50% No 43 28% 27 21% Don't Know 15 10% 24 19% SUBSTANCE ABUSE SERVICES Yes 22 14% 19 15% Within 30 days 11 7% 8 6% Within 90 days (inclusive)* 12 8% 12 10% No 110 72% 82 65% Don't Know 21 14% 25 20% Page 108
Chapter 5 Army Results Table 5.20 2009 AND 2008 ARMY DoDSER TREATMENT HISTORY FOR COMPLETED SUICIDES (cont.) FAMILY ADVOCACY PROGRAMS Yes 11 7% 8 6% Within 30 days 3 2% 4 3% Within 90 days (inclusive)* 5 3% 4 3% No 115 75% 93 74% Don't Know 27 18% 25 20% CHAPLAIN SERVICES Yes 16 10% 20 16% Within 30 days 14 9% 13 10% Within 90 days (inclusive)* 16 10% 15 12% No 63 41% 44 35% Don't Know 74 48% 62 49% OUTPATIENT BEHAVIORAL HEALTH Yes 76 50% 54 43% Within 30 days 42 28% 27 21% Within 90 days (inclusive)* 48 32% 37 29% No 65 42% 58 46% Don't Know 12 8% 14 11% INPATIENT BEHAVIORAL HEALTH Yes 29 19% 20 16% Within 30 days 5 3% 8 6% Within 90 days (inclusive)* 15 10% 10 8% No 108 71% 90 71% Don't Know 16 10% 16 13% HX PHYSICAL HEALTH PROBLEM Yes 35 23% 31 25% Within 30 days 25 16% 19 15% Within 90 days (inclusive)* 28 18% 27 21% No 80 52% 74 59% Don't Know 38 25% 21 17% *Data presented for Within 90 days includes all cases that reported the event Within 30 days. Therefore, summing the two time frames sums to more than the total number of cases in some instances. As shown in Table 5.21, 35% (n=54) of decedents were reported to have taken psychotropic medications prior to their suicides. The majority of these were antidepressant (30%, n=46) and antianxiety medications (14%, n=21). Very few decedents were reported to have taken antimanics, anticonvulsants, or antipsychotics. Page 109
Chapter 5 Army Results Table 5.21 2009 AND 2008 ARMY DoDSER PSYCHOTROPIC MEDICATION USE FOR COMPLETED SUICIDES TAKEN PSYCHOTROPIC MEDS Yes 54 35% 42 33% No 76 50% 61 48% Don't Know 23 15% 23 18% Antidepressants Yes 46 30% 35 28% No 84 55% 65 52% Don't Know 23 15% 26 21% Antianxiety Yes 21 14% 13 10% No 107 70% 85 67% Don't Know 25 16% 28 22% Antimanics Yes 1 1% 1 1% No 127 83% 95 75% Don't Know 25 16% 30 24% Anticonvulsants Yes 4 3% 4 3% No 125 82% 92 73% Don't Know 24 16% 30 24% Antipsychotics Yes 12 8% 5 4% No 116 76% 92 73% Don't Know 25 16% 29 23% Historical/Developmental Factors DoDSER data are collected on historical or developmental factors that precede a suicide event. These data include information about family histories and interpersonal relationships, legal, financial and administrative difficulties, and reports of prior abuse. Family and Relationship History Table 5.22 shows relationship history factors. As in 2008, many decedents were reported to have experienced failed intimate relationships prior to suicide (50%, n=76). Fourteen percent (n=22) of decedents were reported to have experienced relationship difficulties with someone other than a romantic partner, and 54% (n=83) of decedents reportedly experienced some form of failed relationship prior to suicide, including ruptured relationships with friends as well as ruptured intimate relationships. Twenty-seven percent (n=41) had experienced intimate relationship failure within 30 days of taking their lives, and 35% (n=53) within 90 days. Page 110
Chapter 5 Army Results Table 5.22 2009 AND 2008 ARMY DoDSER RELATIONSHIP HISTORY FOR COMPLETED SUICIDES HX FAILED INTIMATE RELATIONSHIP Yes 76 50% 69 55% Within 30 days 41 27% 50 40% Within 90 days (inclusive)* 53 35% 57 45% No 34 22% 30 24% Don t Know 43 28% 27 21% HX FAILED OTHER RELATIONSHIP Yes 22 14% 18 14% Within 30 days 16 10% 10 8% Within 90 days (inclusive)* 18 12% 11 9% No 71 46% 57 45% Don t Know 60 39% 51 40% HX ANY FAILED RELATIONSHIP Yes 83 54% 74 59% Within 30 days 48 31% 53 42% Within 90 days (inclusive)* 60 39% 60 48% No 30 20% 26 21% Don t Know 40 26% 26 21% *Data presented for Within 90 days includes all cases that reported the event Within 30 days. Therefore, summing the two time frames sums to more than the total number of cases in some instances. As summarized in Table 5.23, 20% (n=31) of decedents were reported to have had a family history of behavioral health problems, 5% (n=7) had experienced the death of a family member. Eight percent (n=12) of decedents were reported to have had histories of family illness, and 5% of decedents were reported to have had histories of family member suicide. There were very few reports of suicide among spouses and friends of decedents. Table 5.23 2009 AND 2008 ARMY DoDSER FAMILY HISTORY FOR COMPLETED SUICIDES HX SPOUSE SUICIDE Yes 1 1% 1 1% No 124 81% 102 81% Don't Know 28 18% 23 18% HX FAMILY MEMBER SUICIDE Yes 7 5% 6 5% No 97 63% 69 55% Don't Know 49 32% 51 40% HX FRIEND SUICIDE Yes 1 1% 2 2% No 92 60% 72 57% Don't Know 60 39% 52 41% Page 111
Chapter 5 Army Results Table 5.23 2009 AND 2008 ARMY DoDSER FAMILY HISTORY FOR COMPLETED SUICIDES (cont.) HX DEATH OF FAMILY MEMBER Yes 7 5% 12 10% No 94 61% 65 52% Don't Know 52 34% 49 39% HX DEATH OF FRIEND Yes 5 3% 8 6% No 86 56% 58 46% Don't Know 62 41% 60 48% HX FAMILY ILLNESS Yes 12 8% 7 6% HX FAMILY BEHAVIORAL HEALTH PROBLEMS No 92 60% 61 48% Don't Know 49 32% 58 46% Yes 31 20% 14 11% No 47 31% 31 25% Don't Know 75 49% 81 64% Administrative and Legal History As shown in Table 5.24, decedents had experienced a variety of administrative and legal difficulties prior to suicide. Twelve percent (n=19) had a history of Article 15 proceedings, 9% (n=14) had a history of being absent without leave, and 9% (n=14) had undergone administrative separation proceedings. Civil legal problems and other legal and administrative problems were reported in 11% (n=17) of suicides. Ten percent (n=16) of decedents had reported histories of medical board proceedings. Table 5.24 2009 AND 2008 ARMY DoDSER ADMIN/LEGAL HISTORY FOR COMPLETED SUICIDES HX COURTS MARTIAL Yes 11 7% 2 2% No 114 75% 99 79% Don t Know 28 18% 25 20% HX ARTICLE 15 Yes 19 12% 24 19% No 101 66% 74 59% Don t Know 33 22% 28 22% HX ADMIN SEPARATION Yes 14 9% 9 7% No 111 73% 94 75% Don t Know 28 18% 23 18% HX AWOL Yes 14 9% 9 7% No 115 75% 96 76% Don t Know 24 16% 21 17% Page 112
Chapter 5 Army Results Table 5.24 2009 AND 2008 ARMY DoDSER ADMIN/LEGAL HISTORY FOR COMPLETED SUICIDES (cont.) HX MEDICAL BOARD Yes 16 10% 5 4% No 113 74% 104 83% Don t Know 24 16% 17 13% HX CIVIL LEGAL PROBLEMS Yes 17 11% 25 20% No 97 63% 69 55% Don t Know 39 25% 32 25% HX NON-SELECTION Yes 9 6% 3 2% No 109 71% 85 67% Don t Know 35 23% 38 30% Abuse History Overall, very little abuse history was reported (Table 5.25). Four percent (n=6) had a known history of sexual abuse, 7% (n=10) had a history of emotional abuse, and 7% (n=10) also had a history of physical abuse. Nine percent (n=14) of Army decedents had a known history of perpetrating physical abuse, and half of these incidents (n=2, 4%) occurred within one year of the suicide. A history of sexual harassment was reported in only one case. However, caution should be taken in interpreting these data, given that abuse history was not known for a significant proportion of decedents. Table 5.25 2009 AND 2008 ARMY DoDSER ABUSE HISTORY FOR COMPLETED SUICIDES HX VICTIM PHYSICAL ABUSE Yes 10 7% 7 6% No 82 54% 64 51% Don t Know 61 40% 55 44% HX VICTIM SEXUAL ABUSE Yes 6 4% 6 5% No 87 57% 66 52% Don t Know 60 39% 54 43% HX VICTIM EMOTIONAL ABUSE Yes 10 7% 8 6% No 80 52% 62 49% Don t Know 63 41% 56 44% HX VICTIM SEXUAL HARASSMENT Yes 1 1% 0 0% No 89 58% 69 55% Don t Know 63 41% 57 45% HX PERPETRATOR PHYSICAL ABUSE Yes 14 9% 8 6% No 80 52% 61 48% Don t Know 59 39% 57 45% Page 113
Chapter 5 Army Results Table 5.25 2009 AND 2008 ARMY DoDSER ABUSE HISTORY FOR COMPLETED SUICIDES (cont.) HX PERPETRATOR SEXUAL ABUSE Yes 6 4% 7 6% No 84 55% 65 52% Don t Know 63 41% 54 43% HX PERPETRATOR EMOTIONAL ABUSE Yes 6 4% 8 6% HX PERPETRATOR SEXUAL HARASSMENT No 83 54% 62 49% Don t Know 64 42% 56 44% Yes 4 3% 1 1% No 84 55% 68 54% Don t Know 65 42% 57 45% Financial and Workplace Difficulties Of the financial and workplace issues assessed by DoDSER, the most commonly reported difficulties for decedents were job problems (25%, n=39) and poor work performance (16%, n=24), as shown in Table 5.26. Thirteen percent (n=20) of decedents had a history of difficulties with either supervisors or coworkers, and 8% (n=12) had a history of excessive debt or bankruptcy. Table 5.26 2009 AND 2008 ARMY DoDSER FINANCIAL AND WORKPLACE DIFFICULTIES FOR COMPLETED SUICIDES EXCESSIVE DEBT/BANKRUPTCY Yes 12 8% 11 9% No 84 55% 65 52% Don t Know 57 37% 50 40% HX JOB PROBLEMS Yes 39 25% 25 20% No 71 46% 73 58% Don t Know 43 28% 28 22% HX SUPERVISOR/COWORKER ISSUES Yes 20 13% 18 14% No 83 54% 72 57% Don t Know 50 33% 36 29% HX POOR WORK EVALUATION Yes 24 16% 17 13% No 89 58% 73 58% Don t Know 40 26% 36 29% Page 114
Chapter 5 Army Results Table 5.26 2009 AND 2008 ARMY DoDSER FINANCIAL AND WORKPLACE DIFFICULTIES FOR COMPLETED SUICIDES (cont.) HX UNIT/WORKPLACE HAZING Yes 4 3% 2 2% No 94 61% 84 67% Don t Know 55 36% 40 32% Deployment Factors The 2009 DoDSER captured detailed information pertaining to the Soldier s most recent three deployments. Data include deployment location information as well as a history of direct combat operations. Comparisons of Operation Enduring Freedom/Operation Iraqi Freedom (OEF/OIF) suicide events to non-oef/oif suicide events are reported in Chapter 3. Deployment History As shown in Table 5.27, the majority (65%, n=99) of Army decedents had been deployed as part of OEF/OIF at least once. Fifty-one percent (n=78) had been deployed to only Iraq, and 8% (n=13) had been deployed to multiple OEF/OIF locations. Table 5.27 2009 AND 2008 ARMY DoDSER EVER DEPLOYED TO OEF/OIF FOR COMPLETED SUICIDES HX DEPLOYMENT OEF/OIF AFGHANISTAN 3 2% 9 7% IRAQ 78 51% 57 45% KUWAIT 5 3% 2 2% MULTIPLE OEF/OIF LOCATIONS 13 8% 3 2% NO HX OEF/OIF DEPLOYMENT 54 35% 56 44% Page 115
Chapter 5 Army Results Combat History As shown in Table 5.28, the majority of Army decedents had no known direct combat history (75%, n=115). Of the 38 decedents (25%) with combat history, 24 (63%) were reported to have witnessed killing and 24 (63%) were reported to have seen dead bodies during combat. Table 5.28 2009 AND 2008 ARMY DoDSER COMBAT HISTORY FOR COMPLETED SUICIDES COMBAT HISTORY HX DIRECT COMBAT 38 25% 24 19% Combat Resulted in Injuries/Casualties 31 82% 12 50% Injured in Combat 9 24% 4 17% Witnessed Killing in Combat 24 63% 8 33% Saw Dead Bodies in Combat 24 63% 9 38% Killed Others in Combat 12 32% 1 4% NO DIRECT COMBAT HX 115 75% 102 81% Note: Indented items were only asked in cases for which the respondent indicated that the decedent had participated in direct combat. Percentages for these items reflect proportion of those with combat experience. Page 116
Chapter 5 Army Results Army Results for Non-Fatal Events In addition to DoDSERs collected for suicides, Army DoDSERs were submitted for any suicide-related behavior that resulted in hospitalization or evacuation from theater. Army DoDSER data are presented separately for suicide attempts, self-harm without intent to die, and suicidal ideation only. While there is debate regarding what types of events should be classified as a suicide attempt, the Army DoDSER process has adopted the following definition: A self-inflicted potentially injurious behavior with a nonfatal outcome for which there is evidence (either explicit or implicit) of intent to die. A suicide attempt may or may not result in injury. [3] Therefore, this category includes behaviors for which there is evidence that the individual intended to die, but the event resulted in no injuries. For example, if someone wrestled a firearm away from a Soldier intending to use it on himself, this would be classified as a suicide attempt even though there were no injuries. Self-harm without intent to die is defined as a potentially injurious self-directed behavior for which there is evidence (either implicit or explicit) that the person did not intend to kill himself or herself. Persons engage in these self-harm behaviors when they wish to use the appearance of a suicide attempt to attain some other end (e.g., to seek help, punish others, receive attention, or regulate negative mood). Suicidal ideation only (without an attempt or self-harm) is defined as any self-reported thoughts of engaging in suicide-related behaviors. [3] Data collection processes for Army DoDSERs following non-fatal suicide events differ somewhat from the data collection process for suicides. The data sources used to complete an Army DoDSER for a nonfatal event include medical and behavioral health records, and an interview with the patient is frequently used to collect the required information. The reporting process for non-fatal suicide events requires the Army DoDSER reporter for each MTF to track these events and ensure DoDSER submission. DoDSER respondents are required to submit monthly reports on suicide-related hospitalizations for each MTF by the fifth working day of the following month to identify the number of hospitalizations or evacuations for that MTF. DoDSERs are then expected for events based on these reports. This generally involves coordination with inpatient behavioral health personnel and outpatient behavioral health clinic personnel. Page 117
Chapter 5 Army Results Army DoDSERs Submitted for Non-Fatal Events A total of 2,047 Army DoDSERs for non-fatal events were submitted for 2009. Of these, 502 (25%) were submitted for suicide attempts, 347 (17%) for instances of self-harm without intent to die, and 1198 (59%) for suicidal ideation only, as shown in Table 5.29. Table 5.29 2009 AND 2008 NON-FATAL ARMY DoDSERs SUBMITTED EVENT TYPE Suicide Attempt 502 25% 591 29% Self-Harm (w/o Intent to Die) 347 17% 418 21% Ideation Only 1198 59% 1017 50% Total 2047 59% 2026 50% Dispositional/Personal Factors This section reports data that describe internal characteristics or individual behaviors of Service Members that may have been associated with or contributed to the suicidal events. These factors include demographic characteristics, event setting, suicide attempt method, substance use during the event, possible motive and intent to die, and communication of intent with others. Demographics Table 5.30 shows demographic data for non-fatal events for 2009. Across all non-fatal event types, the majority of Soldiers were male, Caucasian, under 25, and lower enlisted. In addition, the educational level of the majority of Soldiers across event types was high school or the equivalent. Page 118
Chapter 5 Army Results Table 5.30 2009 AND 2008 NON-FATAL ARMY DoDSER DEMOGRAPHICS Suicide Attempt Self-Harm (w/o Intent to Die) Ideation Only GENDER Male 373 74% 454 77% 249 72% 307 73% 924 77% 820 81% Female 129 26% 137 23% 98 28% 111 27% 274 23% 197 19% RACE Asian/Pacific Islander 14 3% 12 2% 11 3% 8 2% 32 3% 27 3% African American 78 16% 77 13% 41 12% 45 11% 186 16% 122 12% Caucasian 319 64% 405 69% 244 71% 289 70% 784 66% 703 70% Hispanic 21 4% 11 2% 6 2% 9 2% 16 1% 12 1% Other/Don t Know/Missing 65 13% 80 14% 44 13% 59 14% 168 14% 142 14% AGE RANGE Under 25 298 59% 381 64% 224 65% 290 69% 752 63% 650 64% 25-29 119 24% 103 17% 75 22% 81 19% 230 19% 175 17% 30-39 69 14% 85 14% 36 10% 40 10% 161 13% 146 14% 40 + 16 3% 22 4% 12 3% 7 2% 54 5% 46 5% RANK E1-E4 373 74% 463 78% 277 80% 357 85% 961 80% 827 81% E5-E9 109 22% 104 18% 51 15% 56 13% 185 15% 161 16% Officer 12 2% 21 4% 12 3% 4 1% 24 2% 18 2% Warrant Officer 1 <1% 0 0% 1 <1% 1 <1% 5 <1% 2 <1% Cadet/Midshipman 2 <1% 1 <1% 5 1% 0 0% 9 1% 5 <1% Does Not Apply 5 1% 2 <1% 1 <1% 0 0% 10 1% 4 <1% COMPONENT Regular 458 91% 533 90% 314 90% 385 92% 1065 89% 911 90% Reserve 16 3% 25 4% 5 1% 13 3% 36 3% 34 3% National Guard 25 5% 31 5% 24 7% 20 5% 80 7% 65 6% Other 3 1% 2 <1% 4 1% 0 0% 13 1% 7 1% Page 119
Chapter 5 Army Results Table 5.30 2009 AND 2008 NON-FATAL ARMY DoDSER DEMOGRAPHICS (cont.) Suicide Attempt Self-Harm (w/o Intent to Die) Ideation Only EDUCATION Some high school 7 1% 7 1% 5 1% 7 2% 7 1% 14 1% GED 89 18% 107 18% 49 14% 54 13% 164 14% 147 14% High school graduate 171 34% 239 40% 169 49% 212 51% 569 48% 442 43% Some college or technical school 142 28% 104 18% 71 20% 82 20% 245 21% 206 20% 2 year degree/certificate 19 4% 28 5% 5 1% 10 2% 37 3% 36 4% Four-year college degree 18 4% 27 5% 15 4% 6 1% 45 4% 23 2% Master s degree or greater 3 1% 8 1% 6 2% 3 1% 13 1% 11 1% Don t Know 53 11% 71 12% 27 8% 44 11% 115 10% 138 14% MARITAL STATUS Never Married 215 43% 264 45% 163 47% 198 47% 586 49% 477 47% Married 220 44% 253 43% 148 43% 172 41% 456 38% 425 42% Legally Separated 15 3% 20 3% 11 3% 9 2% 47 4% 28 3% Divorced 41 8% 38 6% 20 6% 28 7% 71 6% 57 6% Widowed 2 <1% 4 1% 0 0% 3 1% 0 0% 2 <1% Don t Know 9 2% 12 2% 5 1% 8 2% 36 3% 28 3% Page 120
Chapter 5 Army Results Event Setting As shown in Table 5.31, for all types of non-fatal events, the United States was the most commonly reported location. Iraq was the second most common location. However, as shown in the table, this proportion was small, as were the proportions for the remaining locations. Table 5.31 2009 AND 2008 NON-FATAL ARMY DoDSER EVENT COUNTRY Suicide Attempt Self-Harm (w/o Intent to Die) Ideation Only EVENT COUNTRY United States 396 79% 447 76% 295 85% 350 84% 1066 89% 927 91% Iraq 43 9% 80 14% 19 5% 36 9% 50 4% 59 6% Afghanistan 8 2% 10 2% 6 2% 3 1% 9 1% 6 1% Kuwait 3 1% 2 <1% 2 1% 2 <1% 3 <1% 2 <1% Korea 17 3% 18 3% 7 2% 10 2% 6 1% 10 1% Kosovo 0 0% 0 0% 1 <1% 0 0% 1 <1% 0 0% Europe 26 5% 30 5% 13 4% 14 3% 51 4% 13 1% Canada 3 1% 1 <1% 0 0% 0 0% 3 <1% 0 0% Central or South America 0 0% 1 <1% 0 0% 0 0% 1 <1% 0 0% Other 4 1% 0 0% 2 1% 0 0% 0 0% 0 0% Don t Know 2 <1% 2 <1% 2 1% 3 1% 2 <1% 0 0% Page 121
Chapter 5 Army Results As shown in Table 5.32, non-fatal events occurred most often in Soldiers personal residences. Very few self-harm behaviors were reported to have occurred in other locations. Table 5.32 2009 AND 2008 NON-FATAL ARMY DoDSER EVENT SETTING Suicide Attempt Self-Harm (w/o Intent to Die) Ideation Only EVENT SETTING Residence (own) or barracks 397 79% 468 79% 289 83% 357 85% 898 75% 735 72% Residence of friend or family 26 5% 29 5% 10 3% 11 3% 29 2% 26 3% Work/jobsite 8 2% 24 4% 14 4% 16 4% 105 9% 128 13% Automobile 28 6% 18 3% 9 3% 8 2% 35 3% 18 2% Inpatient medical facility 3 1% 4 1% 7 2% 0 0% 6 1% 7 1% Other 40 8% 48 8% 18 5% 26 6% 119 10% 103 10% Page 122
Chapter 5 Army Results Event Method Figure 5.2 and Table 5.33 show the self-harm methods used for each type of non-fatal event. Drugs were most frequently reported. Use of sharp or blunt objects, followed by hanging, were the next most common methods with which Soldiers were reported to have harmed themselves. 100 90 80 70 Percentage 60 50 40 30 57% 54% 2009 2008 20 10 8% 9% 15% 12% 9% 7% 14% 15% 0 Drugs Hanging Sharp or Blunt Object Firearm Other Figure 5.2 2009 AND 2008 NON-FATAL ARMY DoDSER EVENT METHODS Page 123